Vey N, Blaise D, Stoppa A M, Bouabdallah R, Lafage M, Sainty D, Cowen D, Viens P, Lepeu G, Blanc A P
Institut Paoli Calmettes, Marseille, France.
Bone Marrow Transplant. 1994 Sep;14(3):383-8.
Over a 10 year period, we transplanted 63 patients with acute lymphoblastic leukaemia (ALL) who had achieved first complete remission (CR). All were > 15 years old and 45 (71%) had at least one poor prognostic factor. Twenty-nine patients with a suitable sibling underwent autologous bone marrow transplantation (BMT). Beginning in 1984, patients without a donor received an allogeneic BMT (34 patients). Preparation consisted of cyclophosphamide (CY)/TBI (78%) or melphalan (Mel)/TBI (22%); marrow was treated in vitro in 31 patients (allogeneic: 7; autologous: 24). Kaplan-Meier estimates of the probability at 6 years of relapse, survival and DFS were 41% (allogeneic: 10%, autologous: 65%, p < 0.05), 44% (allogeneic: 62%, autologous: 26%, p = NS) and 42% (allogeneic: 62%, autologous: 27%, p < 0.06), respectively. This report confirms that allogeneic BMT permits long-term remissions giving high levels of survival when performed shortly after entering first CR while autologous BMT, when performed in the same setting, is less successful at preventing relapse. This study also confirms the high sensitivity of ALL to the graft-versus-leukemia effect provided by allogeneic BMT. Chemoradiotherapy dose intensification delivered at autologous BMT is not sufficient to prevent relapses. Autologous BMT must therefore be augmented by other approaches of which immunotherapy may be one.
在10年期间，我们对63例急性淋巴细胞白血病（ALL）患者进行了移植，这些患者均已获得首次完全缓解（CR）。所有患者年龄均超过15岁，其中45例（71%）至少有一项不良预后因素。29例有合适同胞供者的患者接受了自体骨髓移植（BMT）。从1984年开始，没有供者的患者接受了异基因BMT（34例）。预处理方案包括环磷酰胺（CY）/全身照射（TBI）（78%）或马法兰（Mel）/TBI（22%）；31例患者的骨髓进行了体外处理（异基因：7例；自体：24例）。采用Kaplan-Meier法估计6年时的复发概率、生存率和无病生存率分别为41%（异基因：10%，自体：65%，p<0.05）、44%（异基因：62%，自体：26%，p=无统计学意义）和42%（异基因：62%，自体：27%，p<0.06）。本报告证实，异基因BMT在首次CR后不久进行时可实现长期缓解并提供较高的生存率，而在相同情况下进行的自体BMT在预防复发方面则不太成功。本研究还证实了ALL对异基因BMT提供的移植物抗白血病效应高度敏感。自体BMT时给予的放化疗剂量强化不足以预防复发。因此，自体BMT必须通过其他方法加强，免疫治疗可能是其中之一。
