Sierra J, Brunet S, Grañena A, Olivé T, Bueno J, Ribera J M, Petit J, Besses C, Llorente A, Guardia R, Macía J, Rovira M, Badell I, Vela E, Díaz de Heredia C, Vivancos P, Carreras E, Feliu E, Montserrat E, Julía A, Cubells J, Rozman C, Domingo A, Ortega J J
Hospital Clinic, Barcelona, Spain.
J Clin Oncol. 1996 Apr;14(4):1353-63. doi: 10.1200/JCO.1996.14.4.1353.
To evaluate prospectively the feasibility and results of bone marrow transplantation (BMT) after induction and intensification chemotherapy (CT) in patients with de novo acute myeloid leukemia (AML).
A total of 159 patients less than 51 years of age were treated. Induction CT consisted of daunorubicin 60 mg/m2 for 3 days, cytarabine (ARA-C) 100mg/m2 for 7 days, and etoposide 100 mg/m2 for 3 days. The first intensification therapy included mitoxantrone 10 mg/m2 for 3 days and ARA-C 1.2 g/m2 every 12 hours for 4 days. Amsacrine (100 or 150 mg/m2 for 3 days) and ARA-C (1.2 g/m2 every 12 hours for 2 or 4 days) were given as the second intensification therapy. Depending on the availability of a human leukocyte antigen (HLA)-identical sibling, the intention of treatment after CT was allogeneic BMT (allo-BMT) or autologous BMT (ABMT).
Complete remission (CR) was obtained in 120 patients (75%) and partial remission (PR) in 11 (7%), while 15 patients (10%) were refractory and 13 (8%) died during induction. There was a trend for better leukemia-free survival (LFS) at 4 years for patients assigned to the ABMT group (50% +/- 6%) compared with the allo-BMT group (31% +/- 7%) (P = .08). This difference in LFS reached statistical significance when considering only transplanted patients (63% +/- 3% at 4 years after ABMT and 38% +/- 11% after allo-BMT, P = .02). The favorable results in patients who received ABMT (no toxic deaths and 37% +/- 7% probability of relapse at 4 years) contrast with the poor outcome of allografted patients (11 patients with transplant-related mortality).
Our study reflects the difficulties in the completion of a therapeutic strategy that include BMT and suggests that intensification before BMT may be useful in the setting of ABMT, but this approach was associated with a high mortality rate in allo-BMT patients.
前瞻性评估初治急性髓系白血病（AML）患者在诱导和强化化疗（CT）后进行骨髓移植（BMT）的可行性及结果。
共治疗了159例年龄小于51岁的患者。诱导CT包括柔红霉素60mg/m²，连用3天；阿糖胞苷（ARA-C）100mg/m²，连用7天；依托泊苷100mg/m²，连用3天。首次强化治疗包括米托蒽醌10mg/m²，连用3天，以及ARA-C 1.2g/m²，每12小时1次，连用4天。第二次强化治疗给予安吖啶（100或150mg/m²，连用3天）和ARA-C（1.2g/m²，每12小时1次，连用2或4天）。根据是否有人类白细胞抗原（HLA）相合的同胞供者，CT后的治疗意向为异基因BMT（allo-BMT）或自体BMT（ABMT）。
120例患者（75%）获得完全缓解（CR），11例（7%）获得部分缓解（PR），15例患者（10%）难治，13例（8%）在诱导期死亡。与allo-BMT组（31%±7%）相比，ABMT组患者4年无白血病生存率（LFS）有更好的趋势（50%±6%）（P = 0.08）。仅考虑移植患者时，LFS的差异具有统计学意义（ABMT后4年为63%±3%，allo-BMT后为38%±11%，P = 0.02）。接受ABMT患者的良好结果（无毒性死亡，4年复发概率为37%±7%）与接受异基因移植患者的不良结局形成对比（11例患者发生移植相关死亡）。
我们的研究反映了完成包括BMT在内的治疗策略存在困难，并表明在ABMT情况下，BMT前的强化治疗可能有用，但这种方法在allo-BMT患者中死亡率较高。
