Gorin N C, Labopin M, Fouillard L, Meloni G, Frassoni F, Iriondo A, Brunet Mauri S, Goldstone A H, Harousseau J L, Reiffers J, Esperou-Bourdeau H, Gluckman E
Hôpital Saint-Antoine, Paris, France.
Bone Marrow Transplant. 1996 Jul;18(1):111-7.
We analyzed retrospectively data from 1696 patients with AML transplanted in Europe from January 1987 to December 1992 and reported to the acute leukemia EBMT registry. Groups of patients were analyzed according to age (adults and children) and status at transplant (first remission = CR1; second remission = CR2). (1) 1114 adult patients were transplanted in CR1; 516 received an allograft; 598 received an autograft. Following alloBMT, the transplant-related mortality (TRM) was significantly higher (27 vs 13%, P < 10(-4)), the relapse incidence (RI) lower (25 vs 52%, P < 10(-4)) and the leukemia-free survival (LFS) better (55 vs 42%, P = 0.006). Favorable prognostic factors for alloBMT were a FAB type other than M4-M5, a donor-recipient combination excluding a female donor to a male recipient, and a younger age. Favorable prognostic factors for ABMT were a younger age of the patients at time of transplant, the AML3 FAB type, and a longer interval from CR1 to ABMT. (2) 288 adult patients were transplanted in CR2: 98 received an allograft; 190 received an autograft. The TRM was higher following allogeneic BMT (32 vs 20%, P = 0.02) and the RI lower (42 vs 63%, P = 0.001). The LFS was not significantly different (alloBMT: 39%; ABMT: 30%, P = 0.22). (3) 242 children were transplanted in CR1; 129 received an allograft; 113 received an autograft. Following alloBMT, the RI was lower (25 + 5 vs 48 + 6%, P < 10(-4)), and the LFS better (68 vs 47%, P = 0.002). The use of TBI was a favorable prognostic factor in allografted patients with a lower RI and a better LFS. (4) The number of children transplanted in CR2 was too small for a comparative analysis. These results confirm that both allogeneic and autologous BMT are suitable curative approaches for AML. They favor the use of an HLA identical related allogeneic transplant when available, especially in younger patients, over ABMT with unpurged marrow. The role of purging in ABMT could not be addressed in this study.
我们回顾性分析了1987年1月至1992年12月间在欧洲接受移植并向急性白血病欧洲骨髓移植登记处报告的1696例急性髓系白血病（AML）患者的数据。根据年龄（成人和儿童）以及移植时的状态（首次缓解=CR1；第二次缓解=CR2）对患者组进行分析。（1）1114例成年患者在CR1期接受移植；516例接受同种异体移植；598例接受自体移植。同种异体骨髓移植（alloBMT）后，移植相关死亡率（TRM）显著更高（27%对13%，P<10⁻⁴），复发率（RI）更低（25%对52%，P<10⁻⁴），无白血病生存率（LFS）更好（55%对42%，P = 0.006）。alloBMT的有利预后因素包括非M4 - M5的FAB类型、排除女性供体给男性受体的供受体组合以及年龄较小。自体骨髓移植（ABMT）的有利预后因素包括移植时患者年龄较小、AML3 FAB类型以及从CR1到ABMT的间隔时间较长。（2）288例成年患者在CR2期接受移植：98例接受同种异体移植；190例接受自体移植。异基因骨髓移植后的TRM更高（32%对20%，P = 0.02），RI更低（42%对63%，P = 0.001）。LFS无显著差异（alloBMT：39%；ABMT：30%，P = 0.22）。（3）242例儿童在CR1期接受移植；129例接受同种异体移植；113例接受自体移植。alloBMT后，RI更低（25% + 5%对48% + 6%，P<10⁻⁴），LFS更好（68%对47%，P = 0.002）。全身照射（TBI）的使用是同种异体移植患者的有利预后因素，RI更低，LFS更好。（4）在CR2期接受移植的儿童数量太少，无法进行比较分析。这些结果证实，同种异体和自体骨髓移植都是治疗AML的合适方法。与未净化骨髓的ABMT相比，在可行时，尤其在年轻患者中，他们更倾向于使用HLA相同的相关同种异体移植。本研究无法探讨ABMT中净化的作用。
