Weisdorf Daniel
University of Minnesota Medical School, Division of Hematology, Oncology and Transplantation, Mayo Mail Code 480, 420 Delaware St SE, Minneapolis, MN 55455, USA.
Best Pract Res Clin Haematol. 2016 Dec;29(4):359-364. doi: 10.1016/j.beha.2016.10.011. Epub 2016 Oct 19.
Management of relapsed leukemia following allogeneic transplantation is challenging. Intensive chemotherapy, donor lymphocyte infusions (DLI), or second transplantation have some value, but most reported series describe only a limited number of patients surviving beyond 2 or 3 years following relapse. Additionally, understandable selection-bias of reports describing the outcomes of intensive management approaches for relapsed leukemia confound generalizability to a broader population. However numerous reports suggest that second allogeneic transplantation for relapsed leukemia following an initial transplant may produce extended disease control and survival for patients with favorable performance status, remission at the time of second transplant, and most importantly a long interval between initial transplant and relapse. Reduced intensity conditioning for second allografts may be preferable and little data exists to suggest that a new donor will improve disease control by inducing a stronger graft-versus-leukemia effect. Improved measures to prevent the first relapse, however, may protect more patients and produce a greater fraction enjoying extended leukemia-free survival.
异基因移植后复发白血病的管理具有挑战性。强化化疗、供体淋巴细胞输注（DLI）或二次移植有一定价值，但大多数报道的系列仅描述了少数复发后存活超过2或3年的患者。此外，描述复发白血病强化管理方法结果的报告中存在可理解的选择偏倚，这使得这些结果难以推广到更广泛的人群。然而，大量报告表明，初次移植后复发白血病的二次异基因移植可能会为身体状况良好、二次移植时处于缓解状态且最重要的是初次移植与复发间隔时间长的患者带来更长时间的疾病控制和生存。二次同种异体移植采用降低强度预处理可能更可取，而且几乎没有数据表明新供体通过诱导更强的移植物抗白血病效应会改善疾病控制。然而，改进预防首次复发的措施可能会保护更多患者，并使更多患者获得更长时间的无白血病生存。
