Ljungman P, de Witte T, Verdonck L, Gahrton G, Freycon F, Gravett P, McCann S, Morgenstern H G, Nikoskelainen J, Powles R
Department of Medicine, Huddinge University Hospital, Sweden.
Br J Haematol. 1993 May;84(1):61-6. doi: 10.1111/j.1365-2141.1993.tb03025.x.
The optimal post-remission therapy for patients with acute myeloblastic leukaemia remains controversial. Allogeneic bone marrow transplantation, autologous bone marrow transplantation, and consolidation chemotherapy are the major options. In order to evaluate their respective value the European Group for Bone Marrow Transplantation conducted a prospective registration study. Patients with newly diagnosed acute myeloblastic leukaemia were registered at the time of HLA-typing and intention to treat in case of presence or absence of an HLA-identical donor was recorded. 27/79 (34%) patients HLA-typed at diagnosis had an identical donor identified. The estimated survivals at 3 years from HLA-typing were 44% and 21% among patients with or without HLA-identical donor, respectively (P = 0.02). 22/26 (85%) patients for whom allogeneic bone marrow transplantation was intended were transplanted but only 15/47 (32%) patients for whom autologous bone marrow transplantation was intended were indeed transplanted (P < 0.001). The survival was 50%, 29% and 17% (P = 0.004) for patients treated with allogeneic bone marrow transplantation, autologous bone marrow transplantation, or chemotherapy, respectively. 40/68 patients HLA-typed in first complete remission had an HLA-identical donor. The estimated 3-year survival among patients typed in first remission with and without HLA-identical donors was 42% and 35% (n.s.), respectively. This technique of early patient registration illustrates the problems of patient selection during the course of the disease and might be used as a complement to randomized trials when comparing bone marrow transplantation and other treatment options.
急性髓细胞白血病患者缓解后的最佳治疗方案仍存在争议。异基因骨髓移植、自体骨髓移植和巩固化疗是主要的选择。为了评估它们各自的价值，欧洲骨髓移植小组进行了一项前瞻性登记研究。新诊断的急性髓细胞白血病患者在进行HLA分型时进行登记，并记录是否存在HLA相合同胞供者的治疗意向。27/79（34%）在诊断时进行HLA分型的患者确定有相合同胞供者。从HLA分型起3年的预计生存率在有或没有HLA相合同胞供者的患者中分别为44%和21%（P = 0.02）。计划进行异基因骨髓移植的22/26（85%）患者接受了移植，但计划进行自体骨髓移植的患者中只有15/47（32%）真正接受了移植（P < 0.001）。接受异基因骨髓移植、自体骨髓移植或化疗的患者生存率分别为50%、29%和17%（P = 0.004）。首次完全缓解时进行HLA分型的68例患者中有40例有HLA相合同胞供者。首次缓解时进行分型且有和没有HLA相合同胞供者的患者预计3年生存率分别为42%和35%（无显著性差异）。这种早期患者登记技术说明了疾病过程中患者选择的问题，并且在比较骨髓移植和其他治疗方案时可用作随机试验的补充。
