Arranz R, Otero M J, Ramos R, Steegmann J L, Lamana M L, Tomás J F, de la Cámara R, Figuera A, Vázquez L, Fernádez-Rañada J M
Department of Haematology, Hospital de la Princesa, Madrid, Spain.
Bone Marrow Transplant. 1994 Apr;13(4):383-7.
Fifty patients with aplastic anemia (AA) were treated with BMT or immunosuppressive therapy (IST). Twenty-one patients underwent BMT using cyclophosphamide (CY) and 7 Gy total lymphoid irradiation (TLI) and cyclosporin A (CsA) plus methotrexate (MTX). Actuarial survival is 71% at 5.3 years with an incidence of graft failure of 0% and of acute GVHD of 38.9%. Univariate analysis of variables influencing survival showed a trend for a poorer outcome in patients who received > 30 transfusions prior to BMT and in male recipients from female donors. Twenty-nine patients > 40 years of age or without matched siblings received antithymocyte/antilymphocyte globulin (ATG/ALG). Response rate to the first course of treatment was 46.4%. Subsequent courses of IST rescued 33% of patients who relapsed or had not responded. Actuarial survival is 62% at 8.6 years. In our experience both treatment strategies have given encouraging results although overall morbidity is higher in the IST group because 25% of patients are therapy or transfusion-dependent. The role of irradiation in the conditioning regimen of BMT patients, recently challenged, is discussed.
五十例再生障碍性贫血（AA）患者接受了骨髓移植（BMT）或免疫抑制治疗（IST）。21例患者采用环磷酰胺（CY）、7Gy全身淋巴照射（TLI）、环孢素A（CsA）加甲氨蝶呤（MTX）进行骨髓移植。5.3年时的实际生存率为71%，移植失败发生率为0%，急性移植物抗宿主病（GVHD）发生率为38.9%。对影响生存的变量进行单因素分析显示，在骨髓移植前接受超过30次输血的患者以及女性供体的男性受者中，预后较差的趋势明显。29例年龄大于40岁或无匹配同胞的患者接受了抗胸腺细胞/抗淋巴细胞球蛋白（ATG/ALG）治疗。第一疗程治疗的缓解率为46.4%。后续的免疫抑制治疗疗程挽救了33%复发或未缓解的患者。8.6年时的实际生存率为62%。根据我们的经验，尽管免疫抑制治疗组的总体发病率较高，因为25%的患者依赖治疗或输血，但两种治疗策略都取得了令人鼓舞的结果。本文还讨论了放疗在骨髓移植患者预处理方案中的作用，该作用最近受到了挑战。
