Irle C, Deeg H J, Buckner C D, Kennedy M, Clift R, Storb R, Appelbaum F R, Beatty P, Bensinger W, Doney K
Leuk Res. 1985;9(10):1255-61. doi: 10.1016/0145-2126(85)90153-5.
Fifty-six patients, 30-47 yr of age, with leukemia in relapse received allogeneic marrow transplants from HLA-identical siblings. All patients were treated with cyclophosphamide (120 mg/kg) and 7 daily fractions of 2.25 Gy of total body irradiation (TBI) for seven consecutive days. Nine patients (16%) are currently alive and free of disease 324-845 days from transplantation. The actuarial relapse and survival rates at 2 yr were 56% and 9.5% respectively. These data were not remarkably different from those in previous studies using 10 Gy of TBI administered as a single dose. Thirty patients were randomized to receive methotrexate (MTX) and 26 to receive cyclosporine (CSP) as postgrafting prophylaxis for acute graft-versus-host disease (GVHD). The probability of developing significant acute GVHD by day 100 post-transplant was 71% for patients in the MTX group and 45% for patients in the CSP group (p less than 0.05). The probability of relapse was 37% for patients in the MTX group and 70% for patients in the CSP group (p less than 0.05). Transplant-related deaths were more frequent in the MTX group and leukemic deaths were more frequent in the CSP group although this may have been related to an uneven distribution of high-risk patients. Long-term disease-free survival was comparable. Patients in the MTX group had more severe mucositis, more alveolar pneumonias and possibly more deaths due to complications of acute and chronic GVHD. Patients in the CSP group had a higher incidence of hypertension, neurological complications and renal dysfunction.
56例年龄在30至47岁之间的白血病复发患者接受了来自HLA相合同胞的异基因骨髓移植。所有患者均接受了环磷酰胺（120mg/kg）治疗，并连续7天每天接受2.25Gy全身照射（TBI），共7个分次。9例患者（16%）目前存活，移植后324至845天无疾病。2年时的精算复发率和生存率分别为56%和9.5%。这些数据与先前使用单次给予10Gy TBI的研究结果没有显著差异。30例患者被随机分配接受甲氨蝶呤（MTX），26例接受环孢素（CSP）作为移植后预防急性移植物抗宿主病（GVHD）的药物。移植后第100天发生显著急性GVHD的概率，MTX组患者为71%，CSP组患者为45%（p<0.05）。MTX组患者的复发概率为37%，CSP组患者为70%（p<0.05）。MTX组与移植相关的死亡更常见，CSP组白血病死亡更常见，尽管这可能与高危患者分布不均有关。长期无病生存率相当。MTX组患者有更严重的粘膜炎、更多的肺泡肺炎，并且可能因急性和慢性GVHD的并发症导致更多死亡。CSP组患者高血压、神经并发症和肾功能障碍的发生率更高。
