Dinsmore R, Kirkpatrick D, Flomenberg N, Gulati S, Kapoor N, Shank B, Reid A, Groshen S, O'Reilly R J
Blood. 1983 Aug;62(2):381-8.
Fifty-two patients with acute lymphoblastic leukemia (ALL) underwent allogeneic bone marrow transplantation following cytoreduction with total body irradiation and cyclophosphamide. Twenty-two patients were in second remission, 15 in a later remission, and 15 were in relapse at the time of the transplant. At a median follow-up of 24 mo, 14 of those in second remission survive in continuous remission compared to 5 in later remission and 4 in the relapse group. Statistical analysis showed an improved disease-free survival for the second remission group (p = 0.09). Patients transplanted in later remission or relapse had a similar survival. The improved survival in second remission resulted from a decreased relapse rate posttransplant, as the early mortality from nonleukemic causes was similar among the groups (p = 0.01). In the second remission patients, no characteristics of the initial leukemia were identified that significantly affected outcome. In the combined later remission and relapse group, poor prognosis posttransplant was associated with initial WBC greater than 20K, age at diagnosis older than 10, or initial remission duration less than or equal to 1 yr. These results suggest that extended disease-free survival may be achieved by second remission transplantation and that improved therapy is necessary for later remission or relapse transplants due to the high rate of posttransplant relapse.
52例急性淋巴细胞白血病（ALL）患者在接受全身照射和环磷酰胺进行细胞减灭术后接受了异基因骨髓移植。22例患者处于第二次缓解期，15例处于较晚缓解期，15例在移植时处于复发状态。中位随访24个月时，第二次缓解期的患者中有14例持续缓解存活，而较晚缓解期的为5例，复发组为4例。统计分析显示第二次缓解期组的无病生存率有所提高（p = 0.09）。在较晚缓解期或复发期进行移植的患者生存率相似。第二次缓解期生存率的提高源于移植后复发率的降低，因为各组非白血病原因导致的早期死亡率相似（p = 0.01）。在第二次缓解期的患者中，未发现初始白血病的特征对预后有显著影响。在较晚缓解期和复发组的联合组中，移植后预后不良与初始白细胞计数大于20K、诊断时年龄大于10岁或初始缓解期小于或等于1年有关。这些结果表明，第二次缓解期移植可能实现延长的无病生存期，并且由于移植后复发率高，对于较晚缓解期或复发期移植而言，改进治疗是必要的。
