Badell I, Ortega J J, Muñoz A, Bureo E, Madero L, Olivé T, Cubells J, Maldonado M S, Baro J, Díaz M A
Sangre (Barc). 1996 Apr;41(2):101-8.
Using the data from the GETMON ("Grupo Español de Trasplante de Medula Osea en Niños") we carried out a retrospective analysis of the results of allogeneic bone marrow transplantation (alloBMT) compared to autologous bone marrow transplantation (ABMT) in 113 paediatric patients with acute lymphoblastic leukaemia (ALL) in second remission. Transplants were performed by the following centers, from April 1983 to December 1991: H. Vall d'Hebrón and H. Sant Pau from Barcelona, H. Ramón y Cajal and H. Niño Jesús from Madrid and H. Marqués de Valdecilla from Santander.
The study included 113 patients between the ages of two and 16 years with ALL in second remission at marrow transplant. Fifty-six underwent alloBMT and 57 ABMT. Both groups were homogeneous with respect to age, sex, immunophenotype, duration of first remission, risk at diagnosis, percentage of early and late relapses, percentage with marrow or extramedullary relapse prior to transplant, time interval from attainment of second remission to transplant, and conditioning regimens applied for marrow transplant, with predominance of chemoradiotherapy in both.
Haematologic recovery was observed to be faster in alloBMT than in ABMT. A granulocyte count > 0.5 x 10(9)/l was reached in alloBMT patients in a median of 19 days and in ABMT patients in a median of 25 days (p < 0.001). Early procedure-related death after ABMT occurred only in one patient (1.75%) and was caused by hepatic veno-occlusive disease. In the alloBMT group, the incidence was 25%. GVHD and infection were the most common causes. Actuarial DFS for alloBMT was 38.8 +/- 6.7% at 8.5 years versus 29.2 +/- 6.5% at 4.5 years for ABMT, p = NS. No significant differences of actuarial DFS were found between alloBMT or ABMT in patients according to leukocyte count and risk at diagnosis, neither with first remission duration, nor with remission duration at transplant. A separate analysis of actuarial DFS for each group shows that in ABMT group DFS was significantly greater in patients who had presented a late relapse (> 30 months) 61.1 +/- 13.8%, than those who had presented an early relapse (< 30 months) 18.3 +/- 6.5% (p < 0.005). Probability of relapse was significantly greater in ABMT (70%) compared to alloBMT (46%) (p < 0.025). Transplant offers a better DFS in extramedullary relapses compared to isolated or combined bone marrow relapses: 71.4 +/- 17.1% with alloBMT and 38.1 +/- 14.7% with ABMT (p = NS).
In our experience we observed a better DFS with alloBMT compared with ABMT, overcoat in early relapses, but without significant difference. A higher relapse rate in ABMT group is partially compensated by more early deaths in alloBMT offers a few survival possibilities in patients with medullary relapses whose first remission lasted less than 30 months.
利用GETMON（“西班牙儿童骨髓移植组”）的数据，我们对113例处于第二次缓解期的急性淋巴细胞白血病（ALL）儿科患者进行了异基因骨髓移植（alloBMT）与自体骨髓移植（ABMT）结果的回顾性分析。移植手术由以下中心于1983年4月至1991年12月期间进行：巴塞罗那的瓦尔德希伯伦医院和圣保禄医院、马德里的拉蒙·卡哈尔医院和尼尼奥·耶稣医院以及桑坦德的瓦尔迪西利亚侯爵医院。
该研究纳入了113例年龄在2至16岁之间、处于骨髓移植第二次缓解期的ALL患者。56例行alloBMT，57例行ABMT。两组在年龄、性别、免疫表型、首次缓解期时长、诊断时的风险、早期和晚期复发率、移植前骨髓或髓外复发率、从达到第二次缓解到移植的时间间隔以及用于骨髓移植的预处理方案方面均具有同质性，两者均以放化疗为主。
观察到alloBMT的血液学恢复比ABMT更快。alloBMT患者粒细胞计数>0.5×10⁹/L的中位时间为19天，ABMT患者为25天（p<0.001）。ABMT术后早期与手术相关的死亡仅发生在1例患者（1.75%），原因是肝静脉闭塞性疾病。在alloBMT组，发生率为25%。移植物抗宿主病（GVHD）和感染是最常见的原因。alloBMT的8.5年精算无病生存率（DFS）为38.8±6.7%，而ABMT的4.5年精算DFS为29.2±6.5%，p=无统计学意义。根据白细胞计数和诊断时的风险，在alloBMT或ABMT患者中，精算DFS在首次缓解期时长、移植时的缓解期时长方面均未发现显著差异。对每组精算DFS的单独分析表明，在ABMT组中，出现晚期复发（>30个月）的患者DFS显著高于出现早期复发（<30个月）的患者，分别为61.1±13.8%和18.3±6.5%（p<0.005）。ABMT的复发概率（70%）显著高于alloBMT（46%）（p<0.025）。与孤立或合并的骨髓复发相比，移植在髓外复发中提供了更好的DFS：alloBMT为71.4±17.1%，ABMT为38.1±14.7%（p=无统计学意义）。
根据我们的经验，与ABMT相比，alloBMT观察到更好的DFS，在早期复发中更为明显，但无显著差异。ABMT组较高的复发率部分被alloBMT中更多的早期死亡所抵消，alloBMT为首次缓解期少于30个月的骨髓复发患者提供了一些生存可能性。
