急性髓性白血病第二次缓解期化疗与移植的对比

Chemotherapy versus transplants for acute myelogenous leukemia in second remission.

作者信息

Gale R P, Horowitz M M, Rees J K, Gray R G, Oken M M, Estey E H, Kim K M, Zhang M J, Ash R C, Atkinson K, Champlin R E, Dicke K A, Gajewski J L, Goldman J M, Helbig W, Henslee-Downey P S, Hinterberger W, Jacobsen N, Keating A, Klein J P, Marmont A M, Prentice H G, Reiffers J, Rimm A A, Bortin M M

机构信息

Salick Health Care, Inc., Division of Bone Marrow and Stem Cell Transplantation, Los Angeles, CA, USA.

出版信息

Leukemia. 1996 Jan;10(1):13-9.

PMID:8558917

Abstract

The best therapy for persons with acute myelogenous leukemia (AML) in 2nd remission is unknown. Bone marrow transplants from an HLA-identical sibling are reported to be better than chemotherapy but this is controversial. The objective of the study was to compare 3-year leukemia-free survival (LFS) in comparable subjects receiving chemotherapy or a transplant. 485 persons with AML in 2nd remission were studied. The chemotherapy cohort included 244 persons treated on trials of the British Medical Research Council, Eastern Cooperative Oncology Group and MD Anderson Hospital. The transplant cohort included 257 persons transplanted worldwide and reported to the international Bone Marrow Transplant Registry (16 were also chemotherapy subjects.) Subjects were selected for comparable age and year of treatment. Preliminary analyses identified two factors correlated with LFS: age < or = or > 30 years and 1st remission duration < or = or > 1 year; subsequent analyses were partitioned accordingly. Three-year probabilities of treatment-related mortality with chemotherapy and transplants were 7% (95% confidence interval, 3-15%) vs 56% (49-63%). Three-year leukemia relapse probabilities were 81% (74-86%) vs 41% (33-49%). Three-year probabilities of LFS were 17% (12-23%) vs 26 (20-32%). Cohort analysis showed significantly higher LFS with transplants vs chemotherapy in persons < or = 30 years and 1st remissions > 1 year (41% (29-53%) vs 17% (7-32%); P = 0.017) and those in > 30 years with 1st remissions < or = 1 year (18% (9-29%) vs 7% (2-16%); P = 0.046). Others had comparable LFS with both treatments. These data indicate better LFS with HLA-identical sibling transplants than chemotherapy in some persons with AML in 2nd remission.

摘要

急性髓性白血病（AML）第二次缓解期患者的最佳治疗方法尚不清楚。据报道，来自 HLA 匹配同胞的骨髓移植比化疗效果更好，但这存在争议。该研究的目的是比较接受化疗或移植的可比受试者的 3 年无白血病生存率（LFS）。对 485 例处于第二次缓解期的 AML 患者进行了研究。化疗队列包括 244 例在英国医学研究委员会、东部肿瘤协作组和 MD 安德森医院的试验中接受治疗的患者。移植队列包括 257 例在全球范围内接受移植并报告给国际骨髓移植登记处的患者（其中 16 例也是化疗受试者）。根据年龄和治疗年份选择可比的受试者。初步分析确定了与 LFS 相关的两个因素：年龄≤或＞30 岁以及首次缓解期≤或＞1 年；随后的分析据此进行划分。化疗和移植的 3 年治疗相关死亡率分别为 7%（95%置信区间，3 - 15%）和 56%（49 - 63%）。3 年白血病复发率分别为 81%（74 - 86%）和 41%（33 - 49%）。3 年 LFS 概率分别为 17%（12 - 23%）和 26%（20 - 32%）。队列分析显示，年龄≤30 岁且首次缓解期＞1 年的患者，移植后的 LFS 显著高于化疗（41%（29 - 53%）对 17%（7 - 32%）；P = 0.017），年龄＞30 岁且首次缓解期≤1 年的患者也是如此（18%（9 - 29%）对 7%（2 - 16%）；P = 0.046）。其他患者两种治疗的 LFS 相当。这些数据表明，对于一些处于第二次缓解期的 AML 患者，与化疗相比，HLA 匹配同胞移植的 LFS 更好。