Martino R, Bellido M, Brunet S, Sureda A, Peyret M, Guárdia R, Altés A, Domingo-Albós A, Sierra J
Clinical Hematology Division, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Bone Marrow Transplant. 1998 May;21(10):1023-7. doi: 10.1038/sj.bmt.1701221.
Over a 9-year period 37 consecutive adults with primary refractory (n = 13) or first relapse of ALL (n = 24) received an intensive salvage chemotherapy regimen with the final intention of undergoing stem cell transplantation (SCT). Twenty-nine patients who achieved complete remission (CR) were assigned to receive autologous SCT (autoSCT) or allogeneic SCT (alloSCT) based on age and availability of a histocompatible sibling. Of the 19 patients assigned to autoSCT, 10 did not reach the transplant due to early relapse (n = 9) or fungal infection (n = 1), and nine were transplanted a median of 2.5 months (1-8) from CR, eight with an immunologically purged graft. One patient died early from ARDS and eight relapsed 2-30 months post-SCT. Three of the 10 patients assigned to alloSCT relapsed early, but all 10 received the assigned transplant a median of 2.5 months (1-7) from CR. Four died from transplant-related complications 0.7-12 months post-SCT, and six are alive and disease-free 9.7-92.6 months after the procedure. In an intention-to-treat analysis, the mean overall survival from CR for those assigned to autoSCT and alloSCT are 11.3 months (0.5-34.3) and 60.1 (2.3-98.3), respectively (log-rank, P < 0.01). Only 65% of patients who reached CR and 51% of the initial 37 cases underwent the intended SCT. We conclude that few adults with refractory or relapsed ALL actually reach SCT in CR even when the protocol used is designed for this purpose. AutoSCT appears to offer little benefit in this setting, and an alloSCT from a related or unrelated donor should be rapidly pursued after achieving CR.
在9年期间，37例连续的原发性难治性急性淋巴细胞白血病（ALL）成人患者（n = 13）或首次复发患者（n = 24）接受了强化挽救化疗方案，最终目的是进行干细胞移植（SCT）。29例获得完全缓解（CR）的患者根据年龄和是否有组织相容性同胞供者被分配接受自体SCT（autoSCT）或异基因SCT（alloSCT）。在分配接受autoSCT的19例患者中，10例因早期复发（n = 9）或真菌感染（n = 1）未进行移植，9例在达到CR后中位2.5个月（1 - 8个月）进行了移植，其中8例使用了免疫净化移植物。1例患者早期死于急性呼吸窘迫综合征（ARDS），8例在SCT后2 - 30个月复发。在分配接受alloSCT的10例患者中，3例早期复发，但所有10例均在达到CR后中位2.5个月（1 - 7个月）接受了分配的移植。4例在SCT后0.7 - 12个月死于移植相关并发症，6例在手术后9.7 - 92.6个月存活且无疾病。在意向性分析中，分配接受autoSCT和alloSCT的患者从CR开始的平均总生存期分别为11.3个月（0.5 - 34.3个月）和60.1个月（2.3 - 98.3个月）（对数秩检验，P < 0.01）。仅65%达到CR的患者和最初37例患者中的51%进行了预期的SCT。我们得出结论，即使所使用的方案是为此目的设计的，很少有难治性或复发性ALL成人患者能在CR时实际进行SCT。在这种情况下，autoSCT似乎益处不大，并应在达到CR后迅速寻求来自相关或无关供者的alloSCT。
