Gratwohl A, Hermans J, van Biezen A, Arcese W, Debusscher L, Ernst P, Ferrant A, Frassoni F, Gahrton G, Iriondo A, Kolb H J, Link H, Niederwieser D, Ruutu T, Siegert W, Zwaan F E
Department of Internal Medicine, Kantonsspital, Basel, Switzerland.
Br J Haematol. 1996 Dec;95(3):494-500. doi: 10.1046/j.1365-2141.1996.d01-1929.x.
A total of 229 patients with chronic myeloid leukaemia (CML) in chronic phase were randomized between 1986 and 1990 to receive or not receive additional splenic irradiation as part of their conditioning prior to bone marrow transplantation (BMT). Both groups, 115 patients with and 114 patients without splenic irradiation, were very similar regarding distribution of age, sex, donor/recipient sex combination, conditioning, graft-versus-host disease (GvHD) prevention method and blood counts at diagnosis or prior to transplant. 135 patients (59%) are alive as of October 1995 with a minimum follow-up of 5 years. 52 patients have relapsed (23%), 26 patients in the irradiated, 26 patients in the non-irradiated group (n.s.) with a relapse incidence at 6 years of 28%. The main risk factor for relapse was T-cell depletion as the method for GvHD prevention, and an elevated basophil count in the peripheral blood prior to transplant. Relapse incidence between patients with or without splenic irradiation was no different in patients at high risk for relapse, e.g. patients transplanted with T-cell-depleted marrows (P = n.s.) and in patients with low risk for relapse, e.g. patients transplanted with non-T-cell-depleted transplants and basophil counts < 3% prior to transplant (P = n.s.). However, relapse incidence differed significantly in patients with non-T-cell-depleted transplants and high basophil counts (> 3% basophils in peripheral blood). In this patient group, relapse incidence was 11% at 6 years with splenic irradiation but 32% in the non-irradiated group (P = 0.05). Transplant-related mortality was similar whether patients received splenic irradiation or not. This study suggests an advantage in splenic irradiation prior to transplantation for CML in this subgroup of patients and illustrates the need for tailored therapy.
1986年至1990年间，共有229例慢性期慢性髓性白血病（CML）患者被随机分组，在骨髓移植（BMT）前作为预处理的一部分接受或不接受额外的脾脏照射。两组，即115例接受脾脏照射的患者和114例未接受脾脏照射的患者，在年龄、性别、供体/受体性别组合、预处理、移植物抗宿主病（GvHD）预防方法以及诊断时或移植前的血细胞计数分布方面非常相似。截至1995年10月，135例患者（59%）存活，最短随访时间为5年。52例患者复发（23%），其中照射组26例，未照射组26例（无统计学差异），6年复发率为28%。复发的主要危险因素是作为GvHD预防方法的T细胞去除，以及移植前外周血嗜碱性粒细胞计数升高。在复发高风险患者中，例如接受T细胞去除骨髓移植的患者（P = 无统计学差异），以及复发低风险患者中，例如接受非T细胞去除移植且移植前嗜碱性粒细胞计数<3%的患者，接受或未接受脾脏照射的患者之间的复发率没有差异（P = 无统计学差异）。然而，在接受非T细胞去除移植且嗜碱性粒细胞计数高（外周血嗜碱性粒细胞>3%）的患者中，复发率有显著差异。在该患者组中，接受脾脏照射的患者6年复发率为11%，而未照射组为32%（P = 0.05）。无论患者是否接受脾脏照射，移植相关死亡率相似。本研究表明，在这一亚组患者中，CML移植前进行脾脏照射具有优势，并说明了个体化治疗的必要性。
