[急性髓细胞白血病首次完全缓解期的骨髓自体移植。41例患者的临床结果]

[Bone marrow autotransplantation in acute myeloblastic leukemia in its first complete remission. The clinical results in 41 patients].

作者信息

Tomás J F, Gómez-García de Soria V, Pinilla I, Lamana M, Figuera A, Arranz R, Cámara R, Fernández-Villalta M J, Alegre A, Fernández-Rañada J M

机构信息

Servicio de Hematología, Hospital Universitario de La Princesa, Madrid.

出版信息

Med Clin (Barc). 1997 Feb 15;108(6):201-6.

PMID:9102484

Abstract

BACKGROUND

A single-center experience using autologous bone marrow transplantation (ABMT) as postremission therapy for acute myeloid leukemia (AML) in first complete remission (CR1) in 41 patients is analyzed.

PATIENTS AND METHODS

From July 1986 to March 1994, 41 patients with AML in CR1 underwent an ABMT. Source of hematopoietic stem cells was bone marrow in all cases. In eleven patients the marrow was purged with mafosfamide (ASTA-Z 7654). Median age was 31 years (17-59) and median time from CR to ABMT was 7 months (3-27). Busulfan (16 mg/kg) and cyclophosphamide (120 mg/kg) was employed as conditioning regimen in 36 patients. The rest 5 patients were prepared with cyclophosphamide (120 mg/kg) and fractioned total body irradiation (12 Gy). Eleven patients received G-CSF after AMBT because of an absolute neutrophil count lower than 0.5 x 10(9) on day +30. Survival analysis was performed according to the methods of Kaplan and Meier and comparison between groups used the log-rank test.

RESULTS

With a median follow-up of 26 months (12-75) 21 patients remain alive in CR. Disease-free survival (DFS) at five years was 40% (95% CI: 25-55%). Transplant-related mortality, mainly for infection and hemorrhage, occurred in 6/41 patients (16%). Leukemia relapse was the main cause of treatment failure: 14/35 (40%). Probability of DFS and relapse was similar for those patients with purged ABMT on unpurged ABMT 45 +/- 23% vs 38 +/- 16% and 37 +/- 14% vs 54 +/- 22% respectively. A significantly longer engraftment time for neutrophils (> 0.5 x 10(9)) and platelets (> 20 x 10(9)) was observed in those patients who received a bone marrow treated with mafosfamide compared with the unpurged group (54 vs 29 days for neutrophils and 102 vs 58 for platelets respectively) (p < 0.05).

CONCLUSIONS

ABMT is a feasible treatment for AML in CR1. Using bone marrow as hematopoietic stem cell support we observed that delayed engraftment was a common finding among AML patients, specially when the marrow was treatment with mafosfamide. Leukemia relapse remains as the main cause of treatment failure for ABMT.

摘要

背景

分析了一家中心对41例首次完全缓解（CR1）的急性髓系白血病（AML）患者采用自体骨髓移植（ABMT）作为缓解后治疗的经验。

患者与方法

1986年7月至1994年3月，41例CR1期AML患者接受了ABMT。所有病例造血干细胞来源均为骨髓。11例患者的骨髓用马磷酰胺（ASTA-Z 7654）进行净化处理。中位年龄为31岁（17 - 59岁），从CR到ABMT的中位时间为7个月（3 - 27个月）。36例患者采用白消安（16mg/kg）和环磷酰胺（120mg/kg）作为预处理方案。其余5例患者采用环磷酰胺（120mg/kg）和分次全身照射（12Gy）进行预处理。11例患者在ABMT后因+30天时绝对中性粒细胞计数低于0.5×10⁹而接受粒细胞集落刺激因子（G-CSF）治疗。根据Kaplan-Meier方法进行生存分析，组间比较采用对数秩检验。

结果

中位随访26个月（12 - 75个月），21例患者仍处于CR状态存活。5年无病生存率（DFS）为40%（95%CI：25% - 55%）。移植相关死亡率主要为感染和出血，发生在6/41例患者（16%）。白血病复发是治疗失败的主要原因：14/35例（40%）。净化ABMT组与未净化ABMT组的DFS概率和复发概率相似，分别为45±23%对38±16%和37±14%对54±22%。与未净化组相比，接受马磷酰胺处理骨髓的患者中性粒细胞（>0.5×10⁹）和血小板（>20×10⁹）的植入时间明显更长（中性粒细胞分别为54天对29天，血小板为102天对58天）（p<0.05）。