Suttorp M, Schmitz N, Leuschner S, Appelt M, Rister M, Schaub J
University Children's Hospital, Kiel, West Germany.
Bone Marrow Transplant. 1989 Dec;4 Suppl 4:144-8.
Nineteen children (median age, 13 years; range 4 to 18 years) with acute lymphoblastic leukemia/lymphoma (ALL) (10 patients) or acute nonlymphoblastic leukemia (ANNL) (9 patients) received allogeneic bone marrow transplants (BMT). Marrow was taken from HLA-identical sibling donors (16 patients) (pts), HLA-identical unrelated donor (1 pt), or one-antigen-missmatched sibling donor (1 pt). Preparatory regimen consisted of fractionated total body irradiation and high-dose VP-16 (50-70 mg/kg body weight). At the time of BMT nine of the pts were not in complete remission (CR): seven pts were refractory to aggressive multiagent chemotherapy and two pts were in first relapse. Six pts were in second CR, one pt in third CR; three pts grafted in first CR carried additional risk factors; e.g. induction failure. Ten out of the nineteen pts are alive and free of disease between one and 53 months (median, 28 months) after BMT. The actuarial disease-free survival rate is 37% for pts with ANLL and 54% for pts with ALL. Six pts have died from BMT-related complications. Only three pts (1 pt with ALL, 2 pts with ANLL) have relapsed between day +106 and day +134 after BMT and subsequently died. The four-year actuarial relapse rates of 29% for ANLL and 14% for ALL, respectively, demonstrate that the combination of fractionated total body irradiation and high-dose VP-16 is an effective antileucemic regimen for children with advanced leukemias.
19名儿童（中位年龄13岁；范围4至18岁）患有急性淋巴细胞白血病/淋巴瘤（ALL）（10例患者）或急性非淋巴细胞白血病（ANNL）（9例患者）接受了异基因骨髓移植（BMT）。骨髓取自HLA相同的同胞供者（16例患者）、HLA相同的无关供者（1例患者）或一个抗原不匹配的同胞供者（1例患者）。预处理方案包括分次全身照射和大剂量VP - 16（50 - 70mg/kg体重）。在进行BMT时，9例患者未达到完全缓解（CR）：7例患者对积极的多药化疗耐药，2例患者处于首次复发。6例患者处于第二次CR，1例患者处于第三次CR；3例在首次CR时进行移植的患者存在其他危险因素，如诱导失败。19例患者中有10例在BMT后1至53个月（中位时间28个月）存活且无疾病。ANNL患者的无病生存率为37%，ALL患者为54%。6例患者死于与BMT相关的并发症。仅3例患者（1例ALL患者，2例ANNL患者）在BMT后第106天至第134天之间复发，随后死亡。ANNL和ALL的四年实际复发率分别为29%和14%，表明分次全身照射和大剂量VP - 16联合应用是晚期白血病儿童有效的抗白血病方案。
