Speck B, Gratwohl A, Osterwalder B, Nissen C, Buser U, Reusser P, Tichelli A, Würsch A, Jeannet M
Schweiz Med Wochenschr. 1984 Oct 6;114(40):1377-9.
Bone marrow transplants were carried out in 18 patients with chronic myelogenous leukemia (CML) in the chronic phase (CP). 12 (67%) are still alive, 11 without evidence of leukemia after a mean observation period of 24 (3-44) months, 1 relapsed and 6 died. The most frequent cause of death was GvHD and interstitial pneumonia (5). 1 patient died of septicemia. 2 grafts were performed in patients with CML in the accelerated phase (AP); both died, one from leukemic relapse and one from GvHD. The authors also participated in an international study in which 117 patients were evaluated. In CP there was a survival plateau at 63%, in AP at 36% and in blastic crisis at 12%. In CP mortality was primarily age-dependent and relapses occurred in only 7%. It is concluded that bone marrow transplantation (BMT) is a highly successful treatment for CML, with the CP the optimum moment for grafting. Longlasting cytogenetic and clinical remissions with potential for cure are possible in a high percentage of patients. The incidence of transplant-related mortality is acceptable. The incidence of leukemic relapse is low in CP. Patients under age 40 with HLA-identical siblings should be transplanted in CP. At present BMT is the only treatment with curative potential for CML.
对18例处于慢性期（CP）的慢性粒细胞白血病（CML）患者进行了骨髓移植。12例（67%）仍然存活，11例在平均24（3 - 44）个月的观察期后无白血病证据，1例复发，6例死亡。最常见的死亡原因是移植物抗宿主病（GvHD）和间质性肺炎（5例）。1例患者死于败血症。对2例处于加速期（AP）的CML患者进行了移植；两人均死亡，1例死于白血病复发，1例死于移植物抗宿主病。作者还参与了一项对117例患者进行评估的国际研究。在慢性期，生存率稳定在63%，加速期为36%，急变期为12%。在慢性期，死亡率主要与年龄有关，复发率仅为7%。结论是骨髓移植（BMT）是治疗CML的一种非常成功的方法，慢性期是移植的最佳时机。在高比例的患者中可以实现持久的细胞遗传学和临床缓解并有治愈的可能。与移植相关的死亡率是可以接受的。慢性期白血病复发率低。40岁以下有 HLA 匹配同胞供者的患者应在慢性期进行移植。目前，骨髓移植是唯一具有治愈CML潜力的治疗方法。
