Higano C S, Raskind W H, Singer J W
University of Washington, Seattle 48195.
Acta Haematol. 1993;89 Suppl 1:8-14. doi: 10.1159/000204578.
The use of recombinant human alpha interferon (IFN) to treat relapse of chronic myelogenous leukemia (CML) in chronic phase after bone marrow transplantation (BMT) was studied in a prospective trial. Relapse was defined as > 90% metaphases containing the Philadelphia chromosome (Ph) and hematologic abnormalities consistent with chronic phase CML. In the initial 18 patients, all received allogeneic marrow, 17 from a related donor, 1 from an unrelated donor. Only 1 patient received T-depleted marrow initially. Three patients had relapsed after second BMT. IFN was started at 3 x 10(6) IU/m2/day and escalated to the maximum tolerated dose or to a maximum of 6 x 10(6) IU/m2/day. Elevated white blood counts and platelet counts were controlled in 14 of 16 and 6 of 6 patients, respectively. Six patients (33%) have had a complete disappearance of the Ph (cytogenetic complete response) and 2 have had a partial response (cytogenetic partial response < 35% Ph+ metaphases but > 0%) on at least one sample. Six patients had no significant response after 9-12 months and 4 patients developed clinical accelerated phase or blast crisis after 3-6 months. IFN controlled the blood counts in 75% of patients. Of 4 patients with a sex marker, the Ph- population was of donor origin in 3 and of host origin in 1. Clonal cytogenetic abnormalities other than the Ph were present in 13 patients and did not predict for lack of response to IFN. IFN effectively produces hematologic control in the majority of patients and suppresses the Ph clone in up to one third. A trial of IFN treatment in an earlier stage of relapse is indicated.
在一项前瞻性试验中研究了重组人α干扰素（IFN）用于治疗骨髓移植（BMT）后慢性期慢性粒细胞白血病（CML）复发的情况。复发定义为超过90%的中期细胞含有费城染色体（Ph）以及符合慢性期CML的血液学异常。最初的18例患者均接受了异基因骨髓移植，17例来自相关供者，1例来自无关供者。仅有1例患者最初接受了去除T细胞的骨髓移植。3例患者在第二次BMT后复发。IFN起始剂量为3×10⁶IU/m²/天，并逐渐增加至最大耐受剂量或最大至6×10⁶IU/m²/天。16例患者中的14例以及6例患者中的6例的白细胞计数和血小板计数升高分别得到了控制。6例患者（33%）出现Ph完全消失（细胞遗传学完全缓解），2例患者至少在一份样本上出现部分缓解（细胞遗传学部分缓解，Ph⁺中期细胞<35%但>0%）。6例患者在9至12个月后无明显反应，4例患者在3至6个月后发展为临床加速期或急变期。IFN使75%的患者血液计数得到控制。在4例有性别标记的患者中，3例Ph阴性群体为供者来源，1例为宿主来源。13例患者存在除Ph之外的克隆性细胞遗传学异常，且这些异常不能预测对IFN无反应。IFN在大多数患者中有效实现血液学控制，且在多达三分之一的患者中抑制Ph克隆。表明应在复发的早期阶段进行IFN治疗试验。
