Carlens S, Ringdén O, Aschan J, Hägglund H, Ljungman P, Mattsson J, Remberger M
Department of Transplantation Surgery, Huddinge University Hospital, Karolinska Institute, Sweden.
Clin Transplant. 1998 Apr;12(2):84-92.
Three hundred and six patients with low- and intermediate-risk leukaemias undergoing allogeneic BMT between 1980 and March 1996 were studied regarding transplantation-related mortality (TRM), relapse, and leukaemia-free survival (LFS). Among the patients were 262 recipients of marrow from HLA-identical siblings and 44 patients receiving marrow from HLA-A, -B, and -DR identical unrelated donors. Between 1986 and 1993, 153 adult patients received ciprofloxacin continuously during Cy conditioning, but since November 1993 ciprofloxacin has not been given until after Cy treatment. TRM at 5 yr showed an incidence of 30%. Significant risk factors in Cox regression multivariate analysis comprised acute GVHD grades II-IV (p < 0.0001), seropositivity for 3-4 herpes viruses prior to BMT (p = 0.002), intermediate risk disease (p = 0.008), female donor to male recipient (p = 0.015), and a donor age over 17 yr (p = 0.025). The risk of relapse was studied from 90 d after BMT, and the overall 5-yr incidence was 32%. Significant risk factors comprised acute leukaemia, as compared to CML (p = 0.003), total body irradiation (TBI) compared to busulphan treatment (p = 0.011), gram-negative prophylaxis with ciprofloxacin during cyclophosphamide (Cy) conditioning (p = 0.024), GVHD prophylaxis using a combination of methotrexate (MTX) and cyclosporine (CSA), compared to monotherapy (p = 0.037) and absence of chronic GVHD (p = 0.050). The 5-yr probability of relapse in patients receiving ciprofloxacin prophylaxis during Cy conditioning was 40%, compared to 24% in patients not receiving this treatment (p = 0.01). Overall, LFS at 5 yr was 49%. LFS was evaluated from day 30 after BMT until relapse or death of the patient. We found no difference in TRM, relapse or LFS between recipients of HLA-identical sibling or unrelated bone marrow, risk factors significantly associated with an inferior LFS included acute GVHD grades II-IV (p = 0.0002), intermediate risk disease (p = 0.003), donor seropositivity for 3-4 herpes viruses (p = 0.046), and TBI conditioning (p = 0.048).
对1980年至1996年3月期间接受异基因骨髓移植的306例低危和中危白血病患者进行了与移植相关死亡率（TRM）、复发率和无白血病生存率（LFS）的研究。患者中有262例接受了来自HLA相同同胞的骨髓，44例接受了来自HLA - A、- B和 - DR相同的无关供体的骨髓。1986年至1993年，153例成年患者在环磷酰胺（Cy）预处理期间持续使用环丙沙星，但自1993年11月起，环丙沙星直到Cy治疗后才给予。5年时的TRM发生率为30%。Cox回归多变量分析中的显著危险因素包括急性移植物抗宿主病（GVHD）II - IV级（p < 0.0001）、骨髓移植前3 - 4种疱疹病毒血清阳性（p = 0.002）、中危疾病（p = 0.008）、女性供体至男性受体（p = 0.015）以及供体年龄超过17岁（p = 0.025）。从骨髓移植后90天开始研究复发风险，总体5年发生率为32%。显著危险因素包括与慢性粒细胞白血病（CML）相比的急性白血病（p = 0.003）、与白消安治疗相比的全身照射（TBI）（p = 0.011）、环磷酰胺（Cy）预处理期间使用环丙沙星进行革兰阴性菌预防（p = 0.024）、与单一疗法相比使用甲氨蝶呤（MTX）和环孢素（CSA）联合进行GVHD预防（p = 0.037）以及无慢性GVHD（p = 0.050）。在Cy预处理期间接受环丙沙星预防的患者中，5年复发概率为40%，而未接受该治疗的患者为24%（p = 0.01）。总体而言，5年时的LFS为49%。LFS从骨髓移植后第30天开始评估，直至患者复发或死亡。我们发现接受HLA相同同胞或无关骨髓的受体在TRM、复发或LFS方面没有差异，与较差LFS显著相关的危险因素包括急性GVHD II - IV级（p = 0.0002）、中危疾病（p = 0.003）、供体3 - 4种疱疹病毒血清阳性（p = 0.046）以及TBI预处理（p = 0.048）。
