Schiller G, Feig S A, Territo M, Wolin M, Lill M, Belin T, Hunt L, Nimer S, Champlin R, Gajewski J
Department of Medicine, UCLA School of Medicine 90024.
Br J Haematol. 1994 Sep;88(1):72-8. doi: 10.1111/j.1365-2141.1994.tb04979.x.
Bone marrow transplantation from a histocompatible sibling donor may produce complete remission in patients with induction failure or relapsed acute leukaemia. Through the National Marrow Donor Program, histocompatible bone marrow from unrelated donors has become available for high-risk patients. In this study we analyse the results of matched unrelated bone marrow transplant in 55 patients with highly advanced acute myelogenous and acute lymphoblastic leukaemia. 28 patients with advanced acute lymphoblastic leukaemia and 27 patients with advanced acute myelogenous leukaemia, age 2-51, were treated with high-dose chemoradiotherapy and transplantation of 6/6 HLA matched (n = 46) or one antigen mismatched (n = 9) unrelated donor bone marrow. After a median follow-up of 36 months, 13 patients remain alive 17-74 months after transplant for a 2-year actuarial disease-free and overall survival of 23 +/- 12% (median disease-free survival 3.5 months). The actuarial risk of relapse is 24 +/- 16% at 1 year. Moderate to severe graft-versus-host disease occurred in 27/47 evaluable patients (57%). Significant prognostic factors for poor leukaemia-free survival include age > 21, abnormal karyotype, and active leukaemia at the time of transplant. Other pretreatment characteristics such as gender or type of leukaemia were not significant prognostic factors. Our results show that matched unrelated bone marrow transplant for patients with advanced acute leukaemia may provide long-term leukaemia-free survival, but transplant-related complications produce a significant impact on survival with older age and adverse disease characteristics predicting for poor prognosis.
来自组织相容性匹配的同胞供体的骨髓移植可能使诱导治疗失败或复发的急性白血病患者获得完全缓解。通过国家骨髓捐赠计划，已可为高危患者提供来自无关供体的组织相容性匹配骨髓。在本研究中，我们分析了55例高危急性髓细胞白血病和急性淋巴细胞白血病患者接受匹配无关骨髓移植的结果。28例高危急性淋巴细胞白血病患者和27例高危急性髓细胞白血病患者，年龄在2至51岁之间，接受了大剂量放化疗，并移植了6/6 HLA匹配（n = 46）或一个抗原不匹配（n = 9）的无关供体骨髓。中位随访36个月后，13例患者在移植后17至74个月仍存活，2年无病生存率和总生存率为23±12%（中位无病生存期3.5个月）。1年时复发的精算风险为24±16%。27/47例可评估患者（57%）发生了中度至重度移植物抗宿主病。无白血病生存期差的显著预后因素包括年龄>21岁、核型异常以及移植时白血病处于活动期。其他预处理特征，如性别或白血病类型，不是显著的预后因素。我们的结果表明，晚期急性白血病患者接受匹配无关骨髓移植可能提供长期无白血病生存，但移植相关并发症对生存有显著影响，年龄较大和疾病特征不良预示预后较差。
