Tomás F, Gómez-García de Soria V, López-Lorenzo J L, Arranz R, Figuera A, Cámara R, Alegre A, Fernández-Rañada J M
Department of Hematology, Hospital Universitario La Princesa, Universidad Autónoma, Madrid, Spain.
Bone Marrow Transplant. 1996 Jun;17(6):979-84.
Between May 1983 and March 1994, 31 patients with AML in second CR underwent BMT. Fifteen underwent allogeneic BMT from an HLA-identical sibling donor and 16 without a donor, unpurged ABMT. Two different preparative regimens were used: CY (120 mg/kg) and 12 Gy of fractioned TBI (19 patients), and Bu (16 mg/kg) and Cy (120 mg/kg) (BuCy2) in 12 patients. Main clinical characteristics including age, sex, length of first remission, FAB type, and number of leukocytes at diagnosis were similar in both groups. A combination of MTX and CsA was used in 13 cases whereas either CsA or MTX alone was employed in the other two patients. With a median follow-up of 5 years the actuarial 5 year probability of disease-free survival (DFS) for the whole group was 39.8% (95% CI: 29.5-50.1%). The 5 year DFS was equivalent for those who received either ABMT (41.6 +/- 14.2%) or allogeneic BMT (40 +/- 15%). Probabilities of relapse and non-relapse mortality for ABMT and allo BMT patients were 48.7 +/- 16.1 and 18.7 +/- 14.3, and 30.1 +/- 19.2 and 40.7 +/- 16.9, respectively. DFS was better in those patients with a longer duration of first CR (> 18 months) 62.5 +/- 14.4 vs 30.4 +/- 17.9%, attributable to a significantly lower relapse rate in this group of patients 16.6 +/- 12.8 vs 57.8 +/- 22.7 (P 0.05). In conclusion, similar results were observed when ABMT and allo BMT were compared for AML in CR2. A higher antileukemic effect associated with the allo BMT is balanced by an increase in transplant-related mortality. Duration of first remission was the most important factor affecting DFS and better outcome was observed for patients with longer CR1.
1983年5月至1994年3月期间，31例处于第二次完全缓解期的急性髓系白血病（AML）患者接受了骨髓移植（BMT）。15例患者接受了来自人类白细胞抗原（HLA）匹配同胞供者的异基因BMT，16例无供者的患者接受了未净化的自体BMT。采用了两种不同的预处理方案：环磷酰胺（CY，120mg/kg）联合12Gy分次全身照射（TBI，19例患者），以及白消安（Bu，16mg/kg）联合环磷酰胺（120mg/kg）（BuCy2方案，12例患者）。两组患者的主要临床特征，包括年龄、性别、首次缓解期时长、FAB分型以及诊断时的白细胞计数均相似。13例患者使用了甲氨蝶呤（MTX）和环孢素（CsA）联合方案，另外2例患者单独使用了CsA或MTX。中位随访时间为5年，全组患者无病生存（DFS）的5年精算概率为39.8%（95%可信区间：29.5 - 50.1%）。接受自体BMT（41.6±14.2%）或异基因BMT（40±15%）的患者5年DFS相当。自体BMT和异基因BMT患者的复发概率及非复发死亡率分别为48.7±16.1和18.7±14.3，以及30.1±19.2和40.7±16.9。首次完全缓解期（CR）持续时间较长（>18个月）的患者DFS更佳，为62.5±14.4%，而较短者为30.4±17.9%，这归因于该组患者的复发率显著更低，分别为16.6±12.8%和57.8±22.7%（P<0.05）。总之，对于处于第二次完全缓解期的AML患者，比较自体BMT和异基因BMT时观察到了相似的结果。异基因BMT相关的更高抗白血病效应被移植相关死亡率的增加所平衡。首次缓解期时长是影响DFS的最重要因素，首次CR期较长的患者预后更佳。
