Enright H, Daniels K, Arthur D C, Dusenbery K E, Kersey J H, Kim T, Miller W J, Ramsay N K, Vercellotti G M, Weisdorf D J, McGlave P B
Bone Marrow Transplantation Program, University of Minnesota Health Sciences Center, Minneapolis, USA.
Bone Marrow Transplant. 1996 Apr;17(4):537-42.
Pre-transplant characteristics of 137 consecutive patients (including 103 patients with one or more features suggesting advanced disease) undergoing related donor marrow transplant for chronic myeloid leukemia (CML) were analyzed to determine their association with outcome. Multivariate analysis identified increased recipient age (relative risk (RR) for patients over 30 years of relapse or death 2.37; P = 0.004), and longer interval between diagnosis and transplant (RR 1.20; P = 0.0001) as significant adverse influences on disease-free survival (DFS). The 5-year DFS for patients transplanted within 1 year of diagnosis (¿early transplant', n = 71) was significantly higher (51%) than that for patients transplanted beyond 1 year from diagnosis ('delayed transplant', n = 55) (34%; log rank P = 0.02). For early transplant patients, poor prognostic features included myelofibrosis (RR 3.53; P = 0.018), splenomegaly (RR 2.22; P = 0.029) and the use of a female donor (RR 3.16; P = 0.002). The 5-year DFS for patients transplanted within 1 year of diagnosis and without signs of advanced disease was 67%. The presence of increasing numbers of features suggesting acceleration prior to transplant had a cumulative adverse influence of DFS. The risk of relapse (5 year estimate 20%) was also independently and significantly increased in association with a longer interval from diagnosis to transplant (P = 0.012). Early transplant is an important influence on DFS and relapse after related donor transplant therapy for CML, although additional patient characteristics influencing outcome can be identified and may have cumulative adverse effects.
对137例接受相关供体骨髓移植治疗慢性粒细胞白血病（CML）的连续患者（包括103例具有一项或多项提示疾病进展特征的患者）的移植前特征进行分析，以确定其与预后的关系。多因素分析确定，受者年龄增加（30岁以上患者复发或死亡的相对风险（RR）为2.37；P = 0.004）以及诊断与移植之间的间隔时间延长（RR 1.20；P = 0.0001）对无病生存期（DFS）有显著不利影响。诊断后1年内移植的患者（“早期移植”，n = 71）的5年DFS显著高于诊断后1年以上移植的患者（“延迟移植”，n = 55）（34%；对数秩检验P = 0.02）。对于早期移植患者，不良预后特征包括骨髓纤维化（RR 3.53；P = 0.018）、脾肿大（RR 2.22；P = 0.029）和使用女性供体（RR 3.16；P = 0.002）。诊断后1年内移植且无疾病进展迹象的患者的5年DFS为67%。移植前提示加速期的特征数量增加对DFS有累积不利影响。复发风险（5年估计值20%）也与诊断至移植的间隔时间延长独立且显著相关（P = 0.012）。早期移植对CML相关供体移植治疗后的DFS和复发有重要影响，尽管可以识别出影响预后的其他患者特征，且这些特征可能有累积不利影响。
