McGlave P, Bartsch G, Anasetti C, Ash R, Beatty P, Gajewski J, Kernan N A
University of Minnesota Medical School, Minneapolis.
Blood. 1993 Jan 15;81(2):543-50.
In the interval from December 1987 to November 1990, 196 consecutive patients with chronic myelogenous leukemia (CML) received unrelated donor marrow transplantation using marrow procured by the National Marrow Donor Program (NMDP) at 21 NMDP-affiliated marrow transplant centers. Baseline donor and recipient data as well as follow-up data were obtained systematically in all cases by the NMDP. The median interval from the initiation of a search for an unrelated donor to bone marrow transplantation was 8.4 months (range, 1.7 to 34.6 months). Median age of the recipients was 33.3 years (4.5 to 54.5 years). Seventy-five recipients were female and 121 were male. At time of transplant, 115 patients were in chronic phase, 51 in accelerated phase, 14 in blast crisis, and 16 in a second or subsequent chronic phase. In 133 cases, donors and recipients were identical at the HLA A, B, and DR loci using standard serologic typing, and in 63 cases, there was nonidentity at one HLA locus. Patients were prepared for transplantation with a combination of high-dose chemotherapy and total body irradiation (N = 169) or with high-dose chemotherapy only (N = 27). Thirty-five patients received marrow depleted ex vivo of T lymphocytes, whereas 161 patients received non-T-depleted marrow. One hundred seventy-four of 196 patients engrafted (absolute neutrophil count > or = 500/mm3 for 3 consecutive days). The median time to engraftment was 22 days (6 to 69 days). Twenty-two patients failed to engraft, and an additional 10 patients experienced late graft failure. The incidence of grades III or IV acute graft-versus-host disease (GVHD) was 0.54 +/- 0.10, and that of extensive chronic GVHD was 0.52 +/- 0.12. A lower incidence of both grades III and IV acute GVHD (P = .0003) and of extensive chronic GVHD (P = .01) were independently associated with use of T-depleted marrow. The actuarial incidence of hematologic relapse at 2 years is 0.11 +/- 0.06. The 2-year actuarial incidence of disease-free survival for patients transplanted in first chronic phase within 1 year of diagnosis is 0.45 +/- 0.21, in chronic phase more than 1 year from diagnosis is 0.36 +/- 0.11, in accelerated phase is 0.27 +/- 0.12, in second or subsequent chronic phase is 0.22 +/- 0.21, and in blast crisis is 0. Fifteen of 55 patients transplanted at 40 to 50 years of age survive.(ABSTRACT TRUNCATED AT 400 WORDS)
在1987年12月至1990年11月期间，196例慢性粒细胞白血病（CML）患者在21个与国家骨髓捐赠项目（NMDP）相关的骨髓移植中心接受了无关供体骨髓移植，所使用的骨髓由NMDP采集。NMDP在所有病例中系统地获取了基线供体和受体数据以及随访数据。从开始寻找无关供体到进行骨髓移植的中位间隔时间为8.4个月（范围为1.7至34.6个月）。受体的中位年龄为33.3岁（4.5至54.5岁）。75名受体为女性，121名为男性。移植时，115例患者处于慢性期，51例处于加速期，14例处于急变期，16例处于第二次或后续慢性期。在133例病例中，使用标准血清学分型，供体和受体在HLA A、B和DR位点相同，在63例病例中，在一个HLA位点存在差异。患者通过大剂量化疗和全身照射联合方案（N = 169）或仅通过大剂量化疗（N = 27）进行移植准备。35例患者接受了体外T淋巴细胞清除的骨髓，而161例患者接受了未清除T细胞的骨髓。196例患者中有174例植入成功（绝对中性粒细胞计数连续3天≥500/mm³）。植入的中位时间为22天（6至69天）。22例患者未植入成功，另外10例患者发生了晚期移植失败。III级或IV级急性移植物抗宿主病（GVHD）的发生率为0.54±0.10，广泛慢性GVHD的发生率为0.52±0.12。使用清除T细胞的骨髓与III级和IV级急性GVHD（P = 0.0003）以及广泛慢性GVHD（P = 0.01）的发生率较低独立相关。2年时血液学复发的精算发生率为0.11±0.06。诊断后1年内处于首次慢性期接受移植的患者2年无病生存的精算发生率为0.45±0.21，诊断后超过1年处于慢性期的患者为0.36±0.11，处于加速期的患者为0.27±0.12，处于第二次或后续慢性期的患者为0.22±0.21，处于急变期的患者为0。55例40至50岁接受移植的患者中有15例存活。（摘要截短至400字）
