Mehta J, Powles R, Singhal S, Horton C, Tait D, Treleaven J
Leukaemia Unit, Royal Marsden Hospital, Sutton, Surrey, UK.
Bone Marrow Transplant. 1996 Jul;18(1):119-23.
Forty-four adults with AML (n = 18) or ALL (n = 26) beyond first remission underwent unpurged (n = 39) or purged (n = 5) autografting after 110-140 mg/m2 melphalan and 1050 cGy TBI. ALL patients were eligible to receive maintenance chemotherapy with 6-mercaptopurine and methotrexate for 2 years after hematologic recovery. The duration of first remission was 1-167 months (median 11). The median time to 50 x 10(9)/I platelets was 76 days, and that to 0.5 x 10(9)/I neutrophils 31 days. Eight patients died of transplant-related toxicity; seven within 1 year. Twenty-two patients relapsed at 1-20 months (median 2.5 months). The 3-year probabilities (95% CI) of relapse and disease-free survival are 58% (43-75%) and 31% (17-45%), respectively. The duration of the first remission (< 1 year vs > or = 1 year) and the stage of transplant (second remission vs other) had no effect on relapse or disease-free survival. There was a trend towards higher relapse rates (76 vs 34%) and poorer disease-free survival (19 vs 49%) among ALL patients compared with AML which did not reach significant levels due to small patient numbers. We conclude that melphalan-TBI is a suitable conditioning regimen for autografting in advanced leukemia. The outcome of AML patients is comparable to standard regimens, but the outcome of ALL patients is poor and measures to enhance the anti-leukemic efficacy are necessary.
44例首次缓解期后的急性髓系白血病（AML，n = 18）或急性淋巴细胞白血病（ALL，n = 26）成人患者，在接受110 - 140 mg/m²美法仑和1050 cGy全身照射（TBI）后，进行了未净化（n = 39）或净化（n = 5）的自体造血干细胞移植。ALL患者在血液学恢复后有资格接受6 - 巯基嘌呤和甲氨蝶呤维持化疗2年。首次缓解期持续时间为1 - 167个月（中位数11个月）。血小板计数达到50×10⁹/L的中位时间为76天，中性粒细胞计数达到0.5×10⁹/L的中位时间为31天。8例患者死于移植相关毒性；7例在1年内死亡。22例患者在1 - 20个月（中位数2.5个月）复发。复发和无病生存的3年概率（95%置信区间）分别为58%（43 - 75%）和31%（17 - 45%）。首次缓解期的持续时间（<1年与≥1年）和移植阶段（第二次缓解期与其他）对复发或无病生存无影响。与AML患者相比，ALL患者有更高复发率（76%对34%）和更差无病生存率（19%对49%）的趋势，但由于患者数量少未达到显著水平。我们得出结论，美法仑 - TBI是晚期白血病自体造血干细胞移植的合适预处理方案。AML患者的结果与标准方案相当，但ALL患者的结果较差，需要采取措施提高抗白血病疗效。
