Hashino S, Imamura M, Kasai M, Higa T, Naohara T, Sakamaki S, Matsunaga T, Kohgo Y, Kohda K, Nakazawa O
Third Department of Internal Medicine, Hokkaido University School of Medicine, Sapporo.
Jpn J Clin Oncol. 1993 Jun;23(3):166-72.
Bone marrow transplantation (BMT) was started in Hokkaido in 1985. In the present report we have reviewed the clinical outcome of patients treated with BMT for hematological diseases in Hokkaido. Fifty-eight allogeneic and 19 autologous transplants were registered by December 1991. The underlying diseases consisted of 47 leukemias, 14 lymphomas, 10 aplastic anemias and six myelodysplastic syndromes. Among the allogeneic BMT cases, 55 were human leucocyte antigen (HLA) identical and three were mismatched. Among the autologous BMT patients, two received their marrow purged with 4-hydroperoxycyclophosphamide and five, with monoclonal antibodies and complements. The conditioning regimens used for malignancies were chiefly cyclophosphamide (CY) plus total body irradiation, or busulfan plus CY. In many cases, cytokines were used for rapid recovery of decreased leukocytes. Engraftment was observed in 50 out of 52 evaluated allogeneic and 18 out of 19 autologous transplants. Ten allogeneic patients suffered from severe acute graft-versus-host diseases (GVHD), and extensive chronic GVHD appeared in 16 patients. Relapses were observed in four cases of allogeneic BMT and six of autologous BMT. The major complications were interstitial pneumonitis (IP) and severe infections. Long-term survival rates were almost 60% in both allogeneic and autologous transplants. Mild acute GVHD and limited chronic GVHD increased the survival rates. The results indicated that substantial problems such as GVHD, IP and relapses must be controlled in the near future for an improved outcome to be made possible.
骨髓移植（BMT）于1985年在北海道开展。在本报告中，我们回顾了北海道接受BMT治疗血液病患者的临床结局。截至1991年12月，共登记了58例异基因移植和19例自体移植。基础疾病包括47例白血病、14例淋巴瘤、10例再生障碍性贫血和6例骨髓增生异常综合征。在异基因BMT病例中，55例人类白细胞抗原（HLA）匹配，3例不匹配。在自体BMT患者中，2例接受了用4-氢过氧环磷酰胺净化的骨髓，5例接受了用单克隆抗体和补体净化的骨髓。用于恶性肿瘤的预处理方案主要是环磷酰胺（CY）加全身照射，或白消安加CY。在许多情况下，使用细胞因子促进减少的白细胞快速恢复。在52例评估的异基因移植中有50例观察到植入，19例自体移植中有18例观察到植入。10例异基因患者发生严重急性移植物抗宿主病（GVHD），16例患者出现广泛慢性GVHD。异基因BMT有4例复发，自体BMT有6例复发。主要并发症是间质性肺炎（IP）和严重感染。异基因和自体移植的长期生存率均接近60%。轻度急性GVHD和局限性慢性GVHD提高了生存率。结果表明，为了改善结局，在不久的将来必须控制诸如GVHD、IP和复发等重大问题。
