Godder K, Pati A, Abhyankar S, Gee A P, Parrish R, Lee C, Henslee-Downey P J
University of South Carolina, Richland Memorial Hospital, USA.
Bone Marrow Transplant. 1996 Jan;17(1):49-53.
Patients who relapse post-ABMT are usually resistant to conventional therapy, and a potentially curative therapy with allogeneic BMT is limited due to availability of a matched donor. To assess whether such patients can be salvaged using partially mismatched related donors (PMRD), eight patients age 6-50 years old underwent PMRD-BMT. All patients ALL (n = 3) and AML (n = 5) were in relapse 7-31 months after first BMT. Donors (1-3 Ag mismatch) were selected from family members. Conditioning included TBI, etoposide, Ara-C and cytoxan (n = 3), or busulfan, thiotepa, and etoposide (n = 5). GVHD prophylaxis consisted of partial T cell depletion followed by systemic immunosuppression. All evaluable patients established sustained engraftment by day 18. Severe regimen-related toxicity was evident in the gastrointestinal and hepatic systems (6/8 and 4/8, respectively), the latter associated with poor outcome (P < 0.014). Acute but not chronic GVHD, grade > or = II occurred in 3/7 patients. Four of eight patients are disease-free, maintaining longer remission than following their first BMT (14 vs 9 months). In conclusion, our data shows that PMRD-BMT is a feasible option for patients who relapse post-BMT and use of such alloreactive grafts may be appropriate earlier in the disease course of high risk patients.
接受自体骨髓移植（ABMT）后复发的患者通常对传统疗法耐药，由于匹配供体的可获得性，同种异体骨髓移植（BMT）这种潜在的治愈性疗法受到限制。为了评估此类患者是否可以使用部分不匹配的相关供体（PMRD）进行挽救，8名年龄在6至50岁的患者接受了PMRD-BMT。所有患者（急性淋巴细胞白血病3例，急性髓细胞白血病5例）在首次BMT后7至31个月复发。供体（1至3个抗原不匹配）从家庭成员中选择。预处理方案包括全身照射（TBI）、依托泊苷、阿糖胞苷和环磷酰胺（3例），或白消安、噻替派和依托泊苷（5例）。移植物抗宿主病（GVHD）预防措施包括部分T细胞清除，随后进行全身免疫抑制。所有可评估的患者在第18天时均实现了持续植入。严重的与方案相关的毒性在胃肠道和肝脏系统中明显（分别为6/8和4/8），后者与不良预后相关（P<0.014）。3/7的患者发生了≥II级的急性而非慢性GVHD。8名患者中有4名无病生存，缓解期比首次BMT后更长（14个月对9个月）。总之，我们的数据表明，PMRD-BMT对于BMT后复发的患者是一种可行的选择，在高危患者的疾病进程中更早使用这种同种异体反应性移植物可能是合适的。
