Kishi K, Takahashi S, Gondo H, Shiobara S, Kanamaru A, Kato S, Hirabayashi N, Moriyama Y, Harada M, Asano S, Hara H, Shibata A
First Department of Internal Medicine, Niigata University School of Medicine, Niigata City, Japan.
Bone Marrow Transplant. 1997 Mar;19(5):461-6. doi: 10.1038/sj.bmt.1700680.
To assess the consequence of second BMT (BMT2) for leukemia relapse after allogeneic BMT, we analyzed the clinical course of 66 recipients who were treated by BMT2 in Japan. Diagnoses included 29 ANLL, 27 ALL, six CML and four MDS. Durations between the first BMT (BMT1) to relapse and BMT1 to BMT2 were 13.5 +/- 13.7 months and 17.4 +/- 13.9 months, respectively. Donors for BMT2 were replaced in 11 cases. Thirty-one patients were in CR (or CP) at BMT2. Earlier deaths were observed in those who received BMT2 within 12 months after BMT1, mostly caused by regimen-related toxicity and infections. Overall leukemia-free survival rate was 28% at 2 years and 16% at 4 years. Factors influencing the poor prognosis after BMT2 were early (<6 months) relapse, early (<12 months) BMT2, not in remission at BMT2, and ALL. Intensified conditioning did not affect either remission duration or LFS. Among the 39 cases observed for more than 100 days, 18 developed chronic GVHD (cGVHD) and showed longer remission duration than those without cGVHD. Our analysis indicates that BMT2 as treatment for leukemia relapse is effective in selected cases, and exploration of pre-BMT treatment and post-BMT immunotherapy is warranted.
为评估异基因骨髓移植（BMT）后第二次骨髓移植（BMT2）对白血病复发的影响，我们分析了日本66例接受BMT2治疗的患者的临床病程。诊断包括29例急性非淋巴细胞白血病（ANLL）、27例急性淋巴细胞白血病（ALL）、6例慢性粒细胞白血病（CML）和4例骨髓增生异常综合征（MDS）。首次骨髓移植（BMT1）至复发以及BMT1至BMT2的时间分别为13.5±13.7个月和17.4±13.9个月。11例患者的BMT2供体进行了更换。31例患者在进行BMT2时处于完全缓解（CR）或部分缓解（CP）状态。在BMT1后12个月内接受BMT2的患者中观察到早期死亡，主要原因是方案相关毒性和感染。2年时总体无白血病生存率为28%，4年时为16%。影响BMT2后预后不良的因素包括早期（<6个月）复发、早期（<12个月）进行BMT2、BMT2时未缓解以及ALL。强化预处理既不影响缓解持续时间也不影响无白血病生存率（LFS）。在观察超过100天的39例患者中，18例发生了慢性移植物抗宿主病（cGVHD），其缓解持续时间比未发生cGVHD的患者更长。我们的分析表明，BMT2作为白血病复发的治疗方法在某些特定病例中是有效的，因此有必要探索移植前治疗和移植后免疫治疗。
