Messina C, Cesaro S, Rondelli R, Rossetti F, Locatelli F, Pession A, Miniero R, Dini G, Uderzo C, Dallorso S, Meloni G, Vignetti M, Andolina M, Porta F, Amici A, Favre C, Basso G, Sotti G, Varotto S, Destro R, Gazzola M V, Pillon M, Petris M G, Rabusin M, Scarzello G
Clinica Onco-Ematologia Pediatrica, Università di Padova, Italy.
Bone Marrow Transplant. 1998 May;21(10):1015-21. doi: 10.1038/sj.bmt.1701204.
From January 1984 to December 1994, ABMT was performed on 154 children (101 males, 53 females; median age 10, range 3-21 years) with ALL and registered for BMT by the AIEOP (Italian Association of Paediatric Haemato-Oncology). All patients were in CR: 98 were in 2nd CR and 56 were in >2nd CR. Fifteen children (9.7%) died of transplant-related mortality. Ninety-five patients (61.6%) relapsed at a median of 5 (range 1-42) months after ABMT. The 8-year EFS according to pre-BMT status was 34.6% (s.e. 4.9) for 2nd CR patients and 10.6% (s.e. 5.6) for patients in >2nd CR. By univariate analysis, site of relapse (isolated extramedullary (IE) vs BM: EFS = 68.5% vs 18.2%; P < 0.0001) and TBI containing regimen (TBI vs no TBI: EFS = 48.1 vs 15.4%; P = 0.0023) were significant factors for 2nd CR patients. When the 2nd CR subset with BM involvement was analysed, TBI became insignificant (EFS = 25.4 vs 11.8%). No factors influenced EFS in patients in >2nd CR. By multivariate analysis, site of relapse was the only significant factor in 2nd CR patients (P < 0.0001). In conclusion, ABMT is an effective treatment after one early IE relapse. Few patients can be rescued after BM relapse.
1984年1月至1994年12月，154名患有急性淋巴细胞白血病（ALL）的儿童（101名男性，53名女性；中位年龄10岁，范围3 - 21岁）接受了自体骨髓移植（ABMT），并由意大利儿科血液肿瘤协会（AIEOP）登记进行骨髓移植。所有患者均处于完全缓解（CR）状态：98名处于第二次完全缓解（2nd CR），56名处于第二次完全缓解后（>2nd CR）。15名儿童（9.7%）死于移植相关死亡率。95名患者（61.6%）在ABMT后中位5个月（范围1 - 42个月）复发。根据移植前状态，第二次完全缓解患者的8年无事件生存率（EFS）为34.6%（标准误4.9），第二次完全缓解后患者为10.6%（标准误5.6）。单因素分析显示，复发部位（孤立髓外复发（IE）与骨髓复发：EFS = 68.5%对18.2%；P < 0.0001）和含全身照射（TBI）方案（TBI与无TBI：EFS = 48.1对15.4%；P = 0.0023）是第二次完全缓解患者的显著因素。当分析有骨髓受累的第二次完全缓解亚组时，TBI变得不显著（EFS = 25.4对11.8%）。没有因素影响第二次完全缓解后患者的EFS。多因素分析显示，复发部位是第二次完全缓解患者唯一的显著因素（P < 0.0001）。总之，ABMT是一次早期孤立髓外复发后的有效治疗方法。骨髓复发后很少有患者能获救。
