Demirer T, Petersen F B, Bensinger W I, Appelbaum F R, Fefer A, Rowley S, Sanders J, Chauncey T, Storb R, Lilleby K, Buckner C D
Fred Hutchinson Cancer Research Center. Seattle, WA 98104, USA.
Bone Marrow Transplant. 1996 Jul;18(1):29-34.
The use of peripheral blood stem cells (PBSC) with or without bone marrow (BM) in patients with acute myelogenous leukemia (AML) undergoing autologous transplantation in untreated first relapse (Rel1) or in second remission (CR2) was evaluated in a phase II study. Twenty-three patients with AML in untreated Rel1 (n = 8) and CR2 (n = 15) underwent autologous transplant using PBSC with (n = 19) or without (n = 4) BM. Six patients received busulfan (BU) and cyclophosphamide (CY) and 17 received BU, CY and total body irradiation prior to transplant. The median number of CD34+ cells infused was 4.81 x 10(6)/kg (range 0.04-15). Fifteen of 23 patients received post-transplant interleukin-2 (IL-2) at a median of 43 days (range 11-93) in an attempt to decrease relapses. The median day of recovery of granulocytes to 0.5 x 10(9)/I was 12 (range 8-27) and platelets to 20 x 10(9)/I was 15 (range 8-103). Patients received a median of 4 units (range 0-20) of red blood cells and 29 units (range 4-252) of platelets. The probability of 100 day non-relapse mortality was 0.14. The probabilities of survival and relapse at 2 years were 0.24 and 0.65, respectively. The probabilities of relapse in patients receiving (n = 15) and not receiving (n = 8) interleukin-2 (IL-2) were 0.59 and 0.74, respectively (P = 0.1). Overall, seven of 23 (30%) patients are alive and continuously disease-free at a median of 483 days (range 113-835) post-transplant. These data demonstrate that the infusion of PBSC collected after rhG-CSF corrected engraftment problems previously observed with autologous BM transplants in patients with AML but was associated with a high relapse rate.
在一项II期研究中，评估了在首次未治疗的复发期（Rel1）或第二次缓解期（CR2）接受自体移植的急性髓性白血病（AML）患者中使用外周血干细胞（PBSC）联合或不联合骨髓（BM）的情况。23例处于未治疗的Rel1期（n = 8）和CR2期（n = 15）的AML患者接受了自体移植，其中19例使用了联合BM的PBSC，4例仅使用了PBSC。6例患者在移植前接受了白消安（BU）和环磷酰胺（CY）治疗，17例接受了BU、CY和全身照射。输注的CD34+细胞中位数为4.81×10⁶/kg（范围0.04 - 15）。23例患者中有15例在移植后中位数43天（范围11 - 93天）接受了白细胞介素-2（IL-2）治疗，试图降低复发率。粒细胞恢复至0.5×10⁹/L的中位数天数为12天（范围8 - 27天），血小板恢复至20×10⁹/L的中位数天数为15天（范围8 - 103天）。患者接受的红细胞中位数为4单位（范围0 - 20），血小板中位数为29单位（范围4 - 252）。100天无复发死亡率为0.14。2年时的生存率和复发率分别为0.24和0.65。接受（n = 15）和未接受（n = 8）白细胞介素-2（IL-2）治疗的患者复发率分别为0.59和0.74（P = 0.1）。总体而言，23例患者中有7例（30%）在移植后中位数483天（范围113 - 835天）存活且持续无病。这些数据表明，输注rhG-CSF后采集的PBSC纠正了AML患者自体BM移植中先前观察到的植入问题，但与高复发率相关。
