Lancet. 1988 Jun 18;1(8599):1379-82.
1957 allogeneic HLA-identical sibling-donor bone-marrow transplants done in 52 European centres between 1979 and 1986 and reported to the European bone-marrow transplant leukaemia registry were analysed. The most important factor influencing leukaemia-free survival, transplant-related mortality, and relapse incidence was the stage of the disease at the time of the transplant. This dominant role of the stage of the disease in all three diagnostic categories--acute myeloblastic leukaemia, acute lymphoblastic leukaemia, and chronic myeloid leukaemia--for all three end-points clearly indicates that resistance of the leukaemia cell to the procedure is more important than bulk of the disease. Additional prognostic factors for leukaemia-free survival and transplant-related mortality were age of the patient, cyclosporin for preventing graft-versus-host disease, and the donor-recipient sex combination. The risk of relapse was highest in patients with acute lymphoblastic leukaemia. In a multivariate analysis leukaemia-free survival was similar for all three major diagnostic categories and has not changed since the introduction of the European registry in 1979. These results show that the biological differences between the three main diagnostic categories of leukaemia are not as great as had been assumed and that the traditional approaches to improving results in recent years have failed.
对1979年至1986年间在52个欧洲中心进行的、并向欧洲骨髓移植白血病登记处报告的1957例同种异体 HLA 相同的同胞供体骨髓移植进行了分析。影响无白血病生存率、移植相关死亡率和复发率的最重要因素是移植时疾病的阶段。疾病阶段在急性髓细胞白血病、急性淋巴细胞白血病和慢性髓细胞白血病这三种诊断类别中，对所有三个终点指标均起主导作用，这清楚地表明白血病细胞对该治疗方法的抗性比疾病的负荷更为重要。无白血病生存率和移植相关死亡率的其他预后因素包括患者年龄、预防移植物抗宿主病使用的环孢素以及供受者性别组合。急性淋巴细胞白血病患者的复发风险最高。在多变量分析中，所有三种主要诊断类别的无白血病生存率相似，自1979年欧洲登记处设立以来并无变化。这些结果表明，白血病的三种主要诊断类别之间的生物学差异并不像之前所认为的那么大，并且近年来改善治疗结果的传统方法已经失败。
