Quah T C, Yeoh A E, Sun L
Department of Paediatrics, National University Hospital, Singapore.
Singapore Med J. 1997 Aug;38(8):344-6.
Acute myeloid leukemia (AML) comprises 15%-20% of childhood acute leukemia cases. The long-term disease free survival (DFS) in childhood AML is poor with standard chemotherapy alone. Early intensive chemotherapy is generally regarded to be necessary for achieving high complete remission (CR) rates. Recent experience has shown that incorporation of early intensification with high-dose melphalan conditioning and autologous bone marrow transplantation (BMT) during the first remission significantly improves long-term DFS in children with AML. In this article, we report the use of autologous BMT for treatment of a three-and-half year old child with acute promyelocytic leukemia (APL or M3) in second remission. The patient was conditioned with high-dose melphalan of 180 mg/kg prior to bone marrow reinfusion. A total of 4.0 x 10(7)/kg mononuclear cells and 1.07 x 10(5)/kg granulomonocytic colony forming units (CFU-GM) were infused. Haematopoietic stem cells were enriched by almost 20-fold after the separation and cryopreservation procedures. Haematological recovery was achieved four-and-a-half weeks post-BMT. She has remained in complete remission 18 months after transplantation. Our experience in this patient indicates that this procedure can be used in second remission and it may provide a better alternative for the management of childhood AML in Singapore.
急性髓细胞白血病（AML）占儿童急性白血病病例的15% - 20%。仅采用标准化疗时，儿童AML的长期无病生存率（DFS）较低。一般认为早期强化化疗对于实现高完全缓解（CR）率是必要的。最近的经验表明，在首次缓解期将早期强化与大剂量美法仑预处理及自体骨髓移植（BMT）相结合，可显著提高AML患儿的长期DFS。在本文中，我们报告了使用自体BMT治疗一名处于第二次缓解期的3岁半急性早幼粒细胞白血病（APL或M3）患儿的情况。在骨髓回输前，该患者接受了180 mg/kg的大剂量美法仑预处理。共输注了4.0×10⁷/kg单个核细胞和1.07×10⁵/kg粒单核细胞集落形成单位（CFU - GM）。经过分离和冷冻保存程序后，造血干细胞富集了近20倍。BMT后四周半实现了血液学恢复。移植后18个月，她一直处于完全缓解状态。我们对该患者的经验表明，此程序可用于第二次缓解期，并且可能为新加坡儿童AML的治疗提供更好的选择。
