Busca A, Anasetti C, Anderson G, Appelbaum F R, Buckner C D, Doney K, Martin P J, Petersdorf E, Sanders J E, Hansen J A
Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA 98104.
Blood. 1994 May 15;83(10):3077-84.
High-dose chemoradiotherapy followed by marrow transplantation from an HLA-matched sibling donor is curative for patients with acute leukemia. Autologous marrow transplantation has been used with success for some patients without such a sibling. Alternatively, the option of performing a transplant from an HLA-matched unrelated donor has been made possible by the recent development of large registries of HLA-typed volunteers. The purpose of this study was to compare the outcomes for patients with advanced leukemia treated by unrelated or autologous marrow transplantation. Forty-three patients with acute myeloid or lymphoid leukemia were transplanted from a closely HLA-matched unrelated donor. Results were compared with those of a disease-, disease-stage-, and age-matched cohort of 77 patients treated with autologous marrow transplantation at the same institution during the same period. Myeloid reconstitution with peripheral granulocyte counts greater than 10(9)/L was achieved in 93% of unrelated recipients and 70% of autologous recipients at a median of 24 and 36 days after transplantation, respectively (P = .0001). The cumulative proportions of patients discharged alive (79% v 77%) and times from transplant to first hospital discharge (35 v 34 days) were not different between unrelated and autologous recipients (P = .65). For patients transplanted in complete remission, relapse occurred after transplantation in 27% of the unrelated and in 55% of the autologous recipients (P = .08). For patients transplanted in relapse, the corresponding posttransplant relapse rates were 48% and 63%, respectively (P = .72). Forty percent of unrelated recipients and 28% of autologous recipients died in remission. Leukemia-free survivals were 33% for unrelated and 25% for autologous recipients transplanted in remission (P = .45), and 12% for unrelated and 5% for autologous recipients transplanted in relapse (P = .75). Unrelated donor transplants appear no less effective than autologous transplants to achieve long-term survival and may be more effective in eradicating leukemia in patients who have failed conventional chemotherapy. Further studies are warranted to assess the relative effectiveness of unrelated and autologous transplantation performed earlier in the course of the disease.
大剂量放化疗后接受来自 HLA 匹配同胞供者的骨髓移植对急性白血病患者具有治愈作用。对于没有此类同胞供者的部分患者，已成功应用自体骨髓移植。另外，由于近期 HLA 分型志愿者大型登记库的发展，使得从 HLA 匹配的无关供者进行移植成为可能。本研究的目的是比较接受无关或自体骨髓移植治疗的晚期白血病患者的结局。43 例急性髓系或淋巴细胞白血病患者接受了来自 HLA 紧密匹配的无关供者的移植。将结果与同期在同一机构接受自体骨髓移植的 77 例疾病、疾病分期和年龄匹配的队列患者的结果进行比较。无关供者受者和自体供者受者外周粒细胞计数大于 10(9)/L 的髓系重建分别在移植后中位 24 天和 36 天实现，比例分别为 93%和 70%（P = 0.0001）。无关供者受者和自体供者受者出院存活患者的累积比例（79%对 77%）以及从移植到首次出院的时间（35 天对 34 天）无差异（P = 0.65）。对于在完全缓解期进行移植的患者，移植后复发率在无关供者受者中为 27%，在自体供者受者中为 55%（P = 0.08）。对于在复发期进行移植的患者，相应的移植后复发率分别为 48%和 63%（P = 0.72）。40%的无关供者受者和 28%的自体供者受者在缓解期死亡。缓解期进行移植的无关供者受者和自体供者受者的无白血病生存率分别为 33%和 25%（P = 0.45），复发期进行移植的无关供者受者和自体供者受者的无白血病生存率分别为 12%和 5%（P = 0.75）。无关供者移植在实现长期生存方面似乎并不比自体移植效果差，并且在根除常规化疗失败患者的白血病方面可能更有效。有必要进行进一步研究以评估在疾病过程中更早进行无关和自体移植的相对有效性。
