Zhang M J, Hoelzer D, Horowitz M M, Gale R P, Messerer D, Klein J P, Löffler H, Sobocinski K A, Thiel E, Weisdorf D J
International Bone Marrow Transplant Registry, Medical College of Wisconsin, Milwaukee 53226, USA.
Ann Intern Med. 1995 Sep 15;123(6):428-31. doi: 10.7326/0003-4819-123-6-199509150-00006.
To determine whether the conclusions of a 1991 study, which showed that adults with acute lymphoblastic leukemia in first remission had similar leukemia-free survival rates when treated with chemotherapy or HLA-identical sibling bone marrow transplantation, remain valid after more than 4 years of additional follow-up.
Retrospective comparison of two cohorts of patients using left-truncated Cox regression to adjust for differences in baseline characteristics and time to treatment.
Chemotherapy recipients were 484 consecutive patients with acute lymphoblastic leukemia in first remission treated in 44 hospitals in Germany that were participating in two consecutive trials of the German Acute Lymphoblastic Leukemia Therapy Trials Group. Transplant recipients were 234 consecutive recipients of HLA-identical sibling bone marrow transplants for acute lymphoblastic leukemia in first remission in 98 centers, worldwide, reporting data to the International Bone Marrow Transplant Registry.
Intensive combination chemotherapy or HLA-identical sibling bone marrow transplantation preceded by high-dose chemotherapy with or without total body irradiation.
Relapse, treatment-related mortality, and leukemia-free survival rate 9 years after first complete remission.
The conclusions of our previous analyses were confirmed. Actuarial relapse probabilities at 9 years were 66% (95% CI, 61% to 70%) for chemotherapy and 30% (CI, 22% to 37%) for transplantation (P < 0.0001). The leukemia-free survival rates at 9 years were 32% (CI, 27% to 37%) for chemotherapy and 34% (CI, 28% to 40%) for transplantation (P > 0.02).
Fewer relapses but more treatment-related deaths were seen with transplantation than with chemotherapy. Thus, leukemia-free survival rates were similar in adults receiving transplantation and adults receiving chemotherapy for acute lymphoblastic leukemia in first remission.
确定1991年一项研究的结论在额外随访4年多后是否仍然有效，该研究表明首次缓解的急性淋巴细胞白血病成人患者接受化疗或人类白细胞抗原（HLA）相合同胞骨髓移植时，其无白血病生存率相似。
采用左截尾Cox回归对两组患者进行回顾性比较，以调整基线特征和治疗时间的差异。
化疗接受者为德国44家医院连续收治的484例首次缓解的急性淋巴细胞白血病患者，这些医院参与了德国急性淋巴细胞白血病治疗试验组的两项连续试验。移植接受者为全球98个中心连续接受HLA相合同胞骨髓移植的234例首次缓解的急性淋巴细胞白血病患者，这些中心向国际骨髓移植登记处报告了数据。
强化联合化疗或HLA相合同胞骨髓移植，移植前进行有或无全身照射的大剂量化疗。
首次完全缓解9年后的复发率、治疗相关死亡率和无白血病生存率。
我们之前分析的结论得到了证实。化疗组9年的精算复发概率为66%（95%可信区间，61%至70%），移植组为30%（可信区间，22%至37%）（P<0.0001）。化疗组9年的无白血病生存率为32%（可信区间，27%至37%），移植组为34%（可信区间，28%至40%）（P>0.02）。
与化疗相比，移植后复发较少，但治疗相关死亡较多。因此，首次缓解的急性淋巴细胞白血病成人患者接受移植和接受化疗的无白血病生存率相似。
