Kantarjian H M, Talpaz M
Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Semin Oncol. 1994 Dec;21(6 Suppl 14):8-13.
Many therapeutic modalities have been or are being investigated for the management of chronic myelogenous leukemia (CML). Conventional chemotherapy with hydroxyurea or busulfan continues to be the most widely prescribed modality. Recent data suggest that hydroxyurea is preferred over busulfan on the basis of survival rates, particularly among patients who undergo bone marrow transplantation. To improve on responses associated with interferon-alfa (IFN-alpha) alone, IFN-alpha has been added to drugs with selective activity against CML. Combining low-dose cytosine arabinoside and IFN-alpha improves outcome in patients with late chronic-phase CML. Preliminary results with homoharringtonine as induction therapy followed by the addition of IFN-alpha as maintenance therapy are also promising in patients with early chronic-phase CML. Enthusiasm regarding allogeneic bone marrow transplantation remains high, but there are problems related to paucity of ideal candidates, controversies regarding optimal timing, and some mortality. Interferon-alfa has been used in the immediate posttransplant period to reverse early cytogenetic relapse in a limited number of patients, which suggests that IFN-alpha also may be useful in preventing relapse in high-risk patients. In autologous bone marrow transplantation, there is interest among investigators in reducing the leukemic burden and altering the marrow microenvironment to favor normal hematopoiesis, but the effect of this alternative on survival is not yet known. Results suggest that young patients are candidates for allogeneic bone marrow transplantation, whereas older patients should be offered IFN-based therapy initially.
许多治疗方法已经或正在被研究用于慢性粒细胞白血病（CML）的治疗。使用羟基脲或白消安的传统化疗仍然是应用最广泛的治疗方式。最近的数据表明，基于生存率，尤其是在接受骨髓移植的患者中，羟基脲比白消安更受青睐。为了改善单独使用α-干扰素（IFN-α）的疗效，IFN-α已与对CML具有选择性活性的药物联合使用。低剂量阿糖胞苷与IFN-α联合使用可改善晚期慢性期CML患者的预后。以高三尖杉酯碱作为诱导治疗，随后添加IFN-α作为维持治疗的初步结果，对于早期慢性期CML患者也很有前景。对异基因骨髓移植的热情仍然很高，但存在理想供体稀缺、最佳时机存在争议以及一些死亡率等问题。在少数患者中，IFN-α已在移植后立即使用以逆转早期细胞遗传学复发，这表明IFN-α在预防高危患者复发方面也可能有用。在自体骨髓移植中，研究人员有兴趣降低白血病负荷并改变骨髓微环境以利于正常造血，但这种替代方法对生存的影响尚不清楚。结果表明，年轻患者是异基因骨髓移植的候选者，而老年患者应首先接受基于IFN的治疗。
