Goldman J M, Apperley J F, Jones L, Marcus R, Goolden A W, Batchelor R, Hale G, Waldmann H, Reid C D, Hows J
N Engl J Med. 1986 Jan 23;314(4):202-7. doi: 10.1056/NEJM198601233140403.
Between February 1981 and December 1984 we treated 52 patients with chronic myeloid leukemia in the chronic phase and 18 patients with more advanced disease by high-dose chemoradiotherapy followed by allogeneic bone marrow transplantation using marrow cells from HLA-identical sibling donors. In addition, the 40 patients who had not previously undergone splenectomy received radiotherapy to the spleen. To prevent graft versus host disease, cyclosporine was given either alone or in conjunction with donor marrow depleted of T cells. Of the 52 patients treated in the chronic phase, 38 are alive after a median follow-up of 25 months (range, 7 to 50); the actuarial survival at two years was 72 percent, and the actuarial risk of relapse was 7 percent. Of the 18 patients with more advanced disease, 4 have survived; the actuarial two-year survival was 18 percent, and the actuarial risk of relapse was 42 percent. We conclude that the probability of cure is highest if transplantation is performed while the patient remains in the chronic phase of chronic myeloid leukemia. T-cell depletion may have reduced the incidence and severity of graft versus host disease. The value of irradiation to the spleen before transplantation has not been established.
1981年2月至1984年12月期间，我们对52例处于慢性期的慢性髓性白血病患者和18例病情更严重的患者进行了大剂量放化疗，随后使用来自人类白细胞抗原（HLA）相合同胞供者的骨髓细胞进行异基因骨髓移植。此外，40例此前未行脾切除术的患者接受了脾脏放疗。为预防移植物抗宿主病，单独给予环孢素或联合去除T细胞的供体骨髓使用。在52例处于慢性期接受治疗的患者中，中位随访25个月（范围7至50个月）后，38例存活；两年的精算生存率为72%，复发的精算风险为7%。在18例病情更严重的患者中，4例存活；两年的精算生存率为18%，复发的精算风险为42%。我们得出结论，如果在慢性髓性白血病患者仍处于慢性期时进行移植，治愈的可能性最高。去除T细胞可能降低了移植物抗宿主病的发生率和严重程度。移植前脾脏放疗的价值尚未确定。
