Vogler W R, Berdel W E
Department of Medicine, Emory University, Atlanta, GA 30322.
J Hematother. 1993 Spring;2(1):93-102. doi: 10.1089/scd.1.1993.2.93.
Autologous bone marrow transplantation (ABMT) appears to offer clinical benefit to leukemia patients, but the major reason for failure is relapse. This may be related to the presence of residual leukemic cells in the harvested marrow. To circumvent this problem, various procedures have been developed to purge ex vivo residual leukemic cells from the marrow. The alkyl-lysophospholipids are a new group of anticancer drugs that target membranes as their major site of action. They are unique in that they are relatively selectively toxic to neoplastic cells and spare normal marrow stem cells and progenitor cells. The most active compound is edelfosine. Twenty-nine patients with acute leukemia in second or subsequent remission or early relapse or in first remission, either with a history of treated extramedullary relapse, or requiring more than one induction program to achieve remission, underwent ablative therapy followed by infusion of autologous marrow which had been purged by a 4-hour exposure to edelfosine prior to cryopreservation. Thirty-one percent of the patients are alive and free of leukemia for a median of 630 days (range 185-1,613). These results in this high-risk group of patients warrant further investigation.
自体骨髓移植（ABMT）似乎能给白血病患者带来临床益处，但失败的主要原因是复发。这可能与采集的骨髓中存在残留白血病细胞有关。为规避这一问题，已开发出各种程序用于在体外清除骨髓中的残留白血病细胞。烷基溶血磷脂是一类新的抗癌药物，其主要作用靶点是细胞膜。它们的独特之处在于对肿瘤细胞具有相对选择性毒性，而使正常骨髓干细胞和祖细胞免受损害。最具活性的化合物是依地福新。29例处于第二次或后续缓解期、早期复发期或首次缓解期的急性白血病患者，要么有髓外复发治疗史，要么需要不止一个诱导方案才能实现缓解，他们接受了清髓性治疗，随后输注自体骨髓，该自体骨髓在冷冻保存前经4小时依地福新处理以清除其中的残留白血病细胞。31%的患者存活且无白血病，中位生存期为630天（范围185 - 1613天）。这些高危患者群体的结果值得进一步研究。
