Michel G, Leverger G, Leblanc T, Nelken B, Baruchel A, Landman-Parker J, Thuret I, Bergeron C, Bordigoni P, Esperou-Bourdeau H, Perel Y, Vannier J P, Schaison G
Hôpital d'Enfants la Timone, Marseille, France.
Bone Marrow Transplant. 1996 Feb;17(2):191-6.
The objective of this study was to compare allogeneic bone marrow transplantation (BMT) with high-dose cytarabine containing chemotherapy in children with acute myeloid leukemia (AML) in first complete remission (CR). One hundred and seventy-one children were enrolled on the LAME89/91 protocol. Induction chemotherapy was a combination of cytarabine and mitoxantrone. After achieving CR, patients who had an HLA-identical sibling donor underwent allogeneic BMT. Children not eligible for BMT received post remission chemotherapy which included two consolidation courses, the second consolidation consisting of high-dose cytarabine with amsacrine and asparaginase. CR was achieved in 149 children (87%). Thirty-two had an HLA-identical sibling donor and were eligible for BMT. These 32 patients, as well as an additional child who had a one antigen HLA-mismatched father, received BMT during first CR. Consequently, 33 patients were analyzed in the BMT group and 116 in the chemotherapy group. The 4-year probability of relapse was 26 +/- 15% in the BMT group and 47 +/- 10% in the chemotherapy group (P = 0.04). The risk of therapy-related death was 3% for BMT and 7.7% for chemotherapy. Disease-free survival (DFS) was 72 +/- 15% in the BMT group and 48 +/- 10% in the chemotherapy group (p = 0.02). We conclude that allogeneic BMT from a matched sibling donor is the treatment of choice for reducing the relapse risk and for increasing DFS in children with AML in first CR.
本研究的目的是比较异基因骨髓移植（BMT）与含大剂量阿糖胞苷的化疗方案对首次完全缓解（CR）的急性髓系白血病（AML）患儿的疗效。171名儿童参加了LAME89/91方案。诱导化疗采用阿糖胞苷和米托蒽醌联合方案。达到CR后，有 HLA 配型相合同胞供者的患者接受异基因BMT。不符合BMT条件的儿童接受缓解后化疗，包括两个巩固疗程，第二个巩固疗程由大剂量阿糖胞苷联合安吖啶和天冬酰胺酶组成。149名儿童（87%）达到CR。32名儿童有 HLA 配型相合的同胞供者，符合BMT条件。这32名患者以及另外一名有一个抗原HLA错配父亲的儿童在首次CR期间接受了BMT。因此，BMT组分析了33例患者，化疗组分析了116例患者。BMT组4年复发概率为26±15%，化疗组为47±10%（P = 0.04）。BMT治疗相关死亡风险为3%，化疗为7.7%。BMT组无病生存率（DFS）为72±15%，化疗组为48±10%（p = 0.02）。我们得出结论，对于降低首次CR的AML患儿的复发风险和提高DFS，来自配型相合同胞供者的异基因BMT是首选治疗方法。
