Cordonnier J M, Mercier M, Plouvier E, Hervé P, Cahn J Y
Laboratoire de Biostatistiques, Faculté de Médecine et de Pharmacie, Besançon, France.
Nouv Rev Fr Hematol (1978). 1994 Aug;36(4):293-300.
Since the treatment of leukaemia by autologous bone marrow transplantation is becoming increasingly frequent, a retrospective study was undertaken to ascertain factors influencing the evolution of the disease (death and relapse). Data were collected over a period of 11 years for 105 patients with acute leukaemia (60 lymphoid cases and 45 myeloid cases). Multivariate analysis by the Cox model was used to determine prognostic factors for survival and disease free survival (DFS). Overall survival for the entire population was 35% after 8 years while DFS was 33% after 3 years. The major prognostic criteria were granulocyte recovery time (p < 0.001 at 5 weeks) and platelet recovery time (p < 0.02 at 6 weeks). Patients conditioned by an association of polychemotherapy and total body irradiation (TBI) showed a better survival rate than those conditioned by polychemotherapy alone (p < 0.01), with an overall survival of 48% after 3 years for the former group as compared to 19% for the latter. Other parameters influencing survival were the number of graft CFU-GM, sex and age. A knowledge of these factors could provide a means of predicting the long term evolution of leukaemia following autologous bone marrow transplantation. However, the present results require validation by a prospective study taking into account recent therapeutic protocols with haematopoietic growth factors.
由于自体骨髓移植治疗白血病的应用日益频繁，因此进行了一项回顾性研究，以确定影响疾病进展（死亡和复发）的因素。收集了105例急性白血病患者（60例淋巴细胞性病例和45例髓细胞性病例）11年期间的数据。采用Cox模型进行多变量分析，以确定生存和无病生存（DFS）的预后因素。整个人群8年后的总生存率为35%，而3年后的DFS为33%。主要的预后标准是粒细胞恢复时间（5周时p<0.001）和血小板恢复时间（6周时p<0.02）。接受联合化疗和全身照射（TBI）预处理的患者的生存率高于仅接受联合化疗预处理的患者（p<0.01），前一组3年后的总生存率为48%，而后一组为19%。影响生存的其他参数是移植物CFU-GM数量、性别和年龄。了解这些因素可为预测自体骨髓移植后白血病的长期进展提供一种方法。然而，目前的结果需要通过前瞻性研究进行验证，该研究要考虑到近期使用造血生长因子的治疗方案。
