Fefer A, Cheever M A, Thomas E D, Appelbaum F R, Buckner C D, Clift R A, Glucksberg H, Greenberg P D, Johnson F L, Kaplan H G, Sanders J E, Storb R, Weiden P L
Blood. 1981 Mar;57(3):421-30.
Thirty-four patients aged 4-67 yr (median 17) with acute lymphocytic leukemia (ALL) (18 patients) or acute nonlymphocytic leukemia (ANL) (16 patients) who failed to enter complete remission (CR) or relapsed on conventional chemotherapy were treated with cyclophosphamide (CY), 60 mg/kg/day for 2 days, 1000 rad total body irradiation, and a marrow transplant from a genotypically identical normal twin. Sixteen of the patients received additional chemotherapy within the week before CY. After the transplant, 23 patients received immunotherapy consisting of killed autologous leukemic cells and/or normal twin peripheral blood lymphocytes, 16 as part of a prospectively randomized study. One moribund patient died before engraftment. Nine patients (6 ALL, 3 ANL) continued to have detectable leukemic cells. Twenty-four patients (70%) achieved CR. One of them died of viral hepatitis at 1 mo and another of viral interstitial pneumonitis at 4 mo in CR. Fourteen patients (7 ALL, 7 ANL) relapsed 2-16 mo (median 4) after transplantation. However, 8 patients (24%) (3 ALL, 5 ANL) remain in CR without any maintenance chemotherapy at 29-103 mo (median 80) after the transplant. The end results were not signficantly influenced by the type of leukemia, the immediated pre-CY chemotherapy, or the immunotherapy. The results show that this approach, even when applied to endstage patients with acute leukemia in relapse, causes tolerable morbidity, rare nonleukemic deaths, and frequent remissions, some of which represent cures.
34例年龄在4至67岁（中位数17岁）的急性淋巴细胞白血病（ALL）患者（18例）或急性非淋巴细胞白血病（ANL）患者（16例），这些患者未能进入完全缓解（CR）或在传统化疗后复发，接受了环磷酰胺（CY）治疗，剂量为60mg/kg/天，共2天，全身照射1000拉德，并接受来自基因型相同的正常双胞胎的骨髓移植。16例患者在接受CY治疗前一周内接受了额外的化疗。移植后，23例患者接受了由灭活的自体白血病细胞和/或正常双胞胎外周血淋巴细胞组成的免疫治疗，其中16例作为前瞻性随机研究的一部分。1例濒死患者在植入前死亡。9例患者（6例ALL，3例ANL）仍有可检测到的白血病细胞。24例患者（70%）实现了CR。其中1例在CR状态下1个月死于病毒性肝炎，另1例在4个月死于病毒性间质性肺炎。14例患者（7例ALL，7例ANL）在移植后2至16个月（中位数4个月）复发。然而，8例患者（24%）（3例ALL，5例ANL）在移植后29至103个月（中位数80个月）仍处于CR状态，未接受任何维持化疗。最终结果未受到白血病类型、CY治疗前即刻化疗或免疫治疗的显著影响。结果表明，这种方法即使应用于复发的晚期急性白血病患者，也会导致可耐受的发病率、罕见的非白血病死亡和频繁的缓解，其中一些代表治愈。
