Bosi A, Bacci S, Miniero R, Locatelli F, Laszlo D, Longo G, Busca A, Van Lint M T, Di Bartolomeo P, Amici A
Department of Hematology, Azienda Ospedaliera Careggi, Firenze, Italy.
Leukemia. 1997 Mar;11(3):420-4. doi: 10.1038/sj.leu.2400585.
Thirty-eight second allogeneic bone marrow transplants (BMT) for acute leukemia relapsed after first BMT were performed in 13 Italian centers between 1987 and 1994. Twenty-one patients had acute myelogenous leukemia (AML), 17 acute lymphoblastic leukemia (ALL); at second BMT 24 patients were in complete remission (CR) and 14 in relapse. The median time to relapse after first BMT was 10 months (range 1-70). Grade II or greater acute graft-versus-host disease (GVHD) after second transplant occurred in 34.2% of patients and a chronic GVHD in 31.5% of patients. Twenty-four patients died: seven from early transplant-related mortality (TRM), 13 from relapse and four from late toxicity. As of 31 July 1996, at a median follow-up of 47 months (range 22-85), there are 14 survivors. The three-year probability of TRM, relapse and event-free survival (EFS) is 28%, 40% and 42% respectively. In 20 of 27 evaluable patients, remission duration after second BMT was longer than after the first BMT. A diagnosis of AML was correlated with a better outcome. These data support the usefulness of second allograft in selected patients with AML relapsing after a first BMT.
1987年至1994年间，意大利的13个中心对38例首次骨髓移植（BMT）后复发的急性白血病患者进行了第二次异基因骨髓移植。其中21例为急性髓性白血病（AML），17例为急性淋巴细胞白血病（ALL）；第二次BMT时，24例患者处于完全缓解（CR）状态，14例复发。首次BMT后至复发的中位时间为10个月（范围1 - 70个月）。第二次移植后，34.2%的患者发生了II级或更严重的急性移植物抗宿主病（GVHD），31.5%的患者发生了慢性GVHD。24例患者死亡：7例死于早期移植相关死亡率（TRM），13例死于复发，4例死于晚期毒性反应。截至1996年7月31日，中位随访47个月（范围22 - 85个月），有14例幸存者。TRM、复发和无事件生存（EFS）的三年概率分别为28%、40%和42%。在27例可评估患者中的20例中，第二次BMT后的缓解期长于第一次BMT。AML诊断与较好的预后相关。这些数据支持了对首次BMT后复发的部分AML患者进行第二次同种异体移植的有效性。
