Weisdorf D J, Billett A L, Hannan P, Ritz J, Sallan S E, Steinbuch M, Ramsay N K
University of Minnesota Department of Medicine, Minneapolis, USA.
Blood. 1997 Oct 15;90(8):2962-8.
Bone marrow transplantation (BMT) can cure patients with high-risk or recurrent acute lymphoblastic leukemia (ALL). Those lacking a related donor can receive either autologous or histocompatible unrelated donor (URD) marrow. Autotransplantation may result in higher risk of relapse, whereas URD allografts, although associated with serious posttransplant toxicities, may reduce relapse risk. Six years (1987 to 1993) of consecutive autologous BMT (University of Minnesota, Dana Farber Cancer Institute; n = 214) were compared with URD transplants (National Marrow Donor Program; n = 337). Most transplants (70% autologous, 48% URD) were in early remission (first or second complete remission [CR1 or CR2]); 376 patients (75% autologous, 64% URD) were less than 18 years old. Autologous BMT led to significantly lower transplant-related mortality (TRM; relative risk [RR] 0.35; P = .001). URD transplantation offered greater protection against relapse (autologous RR 3.1; P = .001). Patients greater than 18 years old, women, and BMT recipients beyond CR2 had higher TRM, whereas adults, BMT recipients in CR2+, or BMT recipients during 1991 through 1993 had significantly more relapse. After 25 months median follow-up, 100 URD and 56 autologous recipients survive leukemia free. URD BMT in CR2 resulted in superior disease-free survival (DFS), especially for adult patients. Multivariate analysis showed superior DFS for children, men, and BMT during CR1 or 2. Autologous and URD BMT can extend survival for a minority of patients unlikely to be cured by chemotherapy, and the results with either technique are comparable. Greater toxicity and TRM after URD BMT are counterbalanced by better protection against relapse. Prospective studies addressing additional clinical variables are needed to guide clinical decision making about transplant choices for patients with ALL.
骨髓移植（BMT）可治愈高危或复发的急性淋巴细胞白血病（ALL）患者。那些没有相关供者的患者可以接受自体或组织相容性不相关供者（URD）骨髓移植。自体移植可能导致更高的复发风险，而URD同种异体移植虽然与移植后严重毒性相关，但可能降低复发风险。对连续六年（1987年至1993年）的自体BMT（明尼苏达大学、达纳法伯癌症研究所；n = 214）与URD移植（国家骨髓供者计划；n = 337）进行了比较。大多数移植（70%为自体，48%为URD）处于早期缓解期（首次或第二次完全缓解[CR1或CR2]）；376例患者（75%为自体，64%为URD）年龄小于18岁。自体BMT导致显著更低的移植相关死亡率（TRM；相对风险[RR] 0.35；P = .001）。URD移植对复发提供了更好的保护（自体RR 3.1；P = .001）。年龄大于18岁的患者、女性以及CR2期以后的BMT受者有更高的TRM，而成年人、CR2+期的BMT受者或1991年至1993年期间的BMT受者有显著更多的复发。经过25个月的中位随访，100例URD受者和56例自体受者无白血病存活。CR2期进行URD BMT可带来更好的无病生存期（DFS），尤其是成年患者。多变量分析显示儿童、男性以及CR1或2期进行BMT有更好的DFS。自体和URD BMT可延长少数不太可能通过化疗治愈的患者的生存期，并且两种技术的结果相当。URD BMT后更大的毒性和TRM被更好的复发保护所抵消。需要针对更多临床变量的前瞻性研究来指导ALL患者移植选择的临床决策。
