Fagioli F, Bacigalupo A, Frassoni F, Van Lint M T, Occhini D, Gualandi F, Lamparelli T, Clavio M, Vitale V, Sogno G
Divisione Ematologia 2, Ospedale San Martino, Genova, Italy.
Bone Marrow Transplant. 1994 Mar;13(3):247-52.
Ninety-one patients with de novo acute myeloid leukemia (AML) in first complete remission (CR) undergoing an HLA-identical sibling BMT and with a minimum follow-up of 12 months were analyzed for disease-related and transplant-related variables predicting survival and relapse. The overall actuarial 5 year survival is 53% and the relapse rate 29%, with a medium follow-up for surviving patients of 1552 days (range 365-4094 days). In univariate analysis the following variables were found to be associated with an increased risk of failure: high-dose cyclosporin (CsA), M4-M6 FAB subtype and a long interval (> or = 180 days) between diagnosis and BMT. Other disease-related variables at presentation were not significant, including WBC count > 50 x 10(9)/l, marrow blasts < 70%, time to enter remission > 40 days and > 2 courses to enter remission. Survival was 58% vs 43% for M1-M3 vs M4-M6 FAB subtypes (p = 0.03) and 71% vs 42% for low-dose vs high-dose CsA (p = 0.01). A multivariate analysis was then run separately on survival, relapse and transplant related mortality (TRM). Survival was negatively influenced by M4-M6 FAB subtypes (p = 0.009), high-dose CsA (p = 0.03) and a long interval between diagnosis and BMT (p = 0.04). Leukemia relapse was higher in patients receiving high-dose CsA (p = 0.003) and in females (p = 0.04). Transplant-related mortality was higher in FAB M4-M6 patients (p = 0.01) and patients grafted late after diagnosis (p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)
对91例初发急性髓细胞白血病（AML）且首次完全缓解（CR）的患者进行了分析，这些患者接受了 HLA 全相合同胞异基因骨髓移植（BMT），且至少随访12个月，分析了预测生存和复发的疾病相关及移植相关变量。总体精算5年生存率为53%，复发率为29%，存活患者的中位随访时间为1552天（范围365 - 4094天）。单因素分析发现，以下变量与失败风险增加相关：高剂量环孢素（CsA）、M4 - M6 FAB 亚型以及诊断与 BMT 之间的间隔时间长（≥180天）。其他疾病相关的初始变量无显著意义，包括白细胞计数>50×10⁹/L、骨髓原始细胞<70%、进入缓解的时间>40天以及进入缓解需要>2个疗程。M1 - M3与M4 - M6 FAB 亚型的生存率分别为58%和43%（p = 0.03），低剂量与高剂量 CsA 的生存率分别为71%和42%（p = 0.01）。然后分别对生存、复发和移植相关死亡率（TRM）进行多因素分析。生存受到M4 - M6 FAB 亚型（p = 0.009）、高剂量 CsA（p = 0.03）以及诊断与 BMT 之间间隔时间长（p = 0.04）的负面影响。接受高剂量 CsA 的患者（p = 0.003）和女性患者（p = 0.04）的白血病复发率更高。FAB M4 - M6 患者（p = 0.01）和诊断后晚期移植的患者（p = 0.03）的移植相关死亡率更高。（摘要截断于250字）
