Maldonado M S, Otheo de Tejada E, Muñoz Villa A, García Laraña J
Servicio de Pediatría, Hospital Ramón y Cajal, Madrid.
Sangre (Barc). 1993 Feb;38(1):13-6.
Long disease-free survival can be achieved with chemotherapy in over 50% of children with acute lymphoblastic leukaemia (ALL). However, those children suffering relapse or presenting with poor-risk features at diagnosis have scarce possibility of doing well with conventional chemotherapy. Bone marrow transplantation (BMT) is a good choice in such cases.
Between July 1985 and January 1992, twenty-four children with ALL underwent BMT in the Service of Pediatrics of the Hospital Ramón y Cajal. In seven patient with poor-risk criteria at diagnosis BMT was performed in the first complete remission (CR) and in seventeen cases it was performed after the second CR. The conditioning for transplantation consisted of cyclophosphamide plus total body irradiation in 21 patients and cyclophosphamide plus busulphan in 3 others.
Fifteen patients persist in CR with post-transplant follow-up of 3 to 73 months (median, 31 months). Five patients died due to complications of the transplantation techniques, and four others died upon leukaemic relapse. The probability of disease-free survival for all cases is 61%, a plateau being reached at 13 months (83% and 52% for BMT in first or second CR, respectively).
These findings confirm the efficacy of BMT in the treatment of children with ALL in second CR, or in first CR when there are very poor risk criteria at diagnosis.
超过50%的急性淋巴细胞白血病（ALL）患儿通过化疗可实现较长的无病生存期。然而，那些复发或在诊断时具有高危特征的患儿，采用传统化疗预后良好的可能性很小。骨髓移植（BMT）在这种情况下是一个不错的选择。
1985年7月至1992年1月期间，24例ALL患儿在拉蒙·y·卡哈尔医院儿科接受了BMT。7例诊断时具有高危标准的患者在首次完全缓解（CR）时进行了BMT，17例在第二次CR后进行了BMT。21例患者的移植预处理方案为环磷酰胺加全身照射，另外3例为环磷酰胺加白消安。
15例患者在移植后随访3至73个月（中位数31个月）仍处于CR状态。5例患者死于移植技术相关并发症，另外4例死于白血病复发。所有病例的无病生存概率为61%，在13个月时达到平台期（首次或第二次CR时进行BMT的无病生存概率分别为83%和52%）。
这些结果证实了BMT治疗第二次CR或诊断时具有极高危标准的首次CR的ALL患儿的疗效。
