Simpson D R, Nevill T J, Shepherd J D, Fung H C, Horsman D E, Nantel S H, Vickars L M, Sutherland H J, Toze C L, Hogge D E, Klingemann H G, Naiman S C, Barnett M J
Division of Hematology, British Columbia Cancer Agency, Vancouver Hospital and Health Sciences Centre, Canada.
Bone Marrow Transplant. 1998 Aug;22(3):259-64. doi: 10.1038/sj.bmt.1701319.
While allogeneic stem cell transplantation (SCT) is curative for a significant number of patients with AML, relapse of disease within the bone marrow and/or extramedullary (EM) sites following high-dose therapy continues to limit the success of this treatment. Between October 1985 and December 1996, 81 adults underwent allogeneic SCT for de novo AML at our centre. Forty-two patients remain alive and free of leukaemia with a median follow-up of 50 months. The 5-year actuarial event-free survivals (EFS) for all patients and for those undergoing SCT in CR1 or with advanced disease were 46% (95% confidence interval (CI) 34-58%), 63% (CI 46-76%), and 19% (CI 7-36%), respectively. Twenty-two patients relapsed at a median of 8 (range 1.6-54.5) months with the actuarial risk of relapse for all, CR1 and advanced disease patients being 38%, (CI 27-52%), 23% (CI 13-40%) and 68% (CI 46-88%), respectively. Ten patients relapsed at EM sites; six of these (27% of relapses) had an isolated EM relapse at a median of 31 (range 8.5-54) months. Three of the patients with isolated EM relapse survived > or =24 months following relapse and two patients remain disease-free at 29+ and 33+ months. BuCy conditioning followed by allogeneic SCT in AML results in satisfactory EFS although there is a significant risk of late isolated EM relapse.
虽然异基因干细胞移植（SCT）可治愈大量急性髓系白血病（AML）患者，但大剂量治疗后骨髓和/或髓外（EM）部位的疾病复发仍然限制了这种治疗方法的成功率。1985年10月至1996年12月期间，81名成人在我们中心接受了异基因SCT治疗初发AML。42例患者仍然存活且无白血病，中位随访时间为50个月。所有患者以及在完全缓解（CR1）期或疾病进展期接受SCT患者的5年无事件生存率（EFS）分别为46%（95%置信区间（CI）34 - 58%）、63%（CI 46 - 76%）和19%（CI 7 - 36%）。22例患者复发，中位复发时间为8（范围1.6 - 54.5）个月，所有患者、CR1期患者和疾病进展期患者的复发精算风险分别为38%（CI 27 - 52%）、23%（CI 13 - 40%）和68%（CI 46 - 88%）。10例患者在髓外部位复发；其中6例（占复发患者的27%）为孤立性髓外复发，中位复发时间为31（范围8.5 - 54）个月。3例孤立性髓外复发患者在复发后存活≥24个月，2例患者在29 +和33 +个月时仍无疾病。AML患者采用环磷酰胺联合白消安预处理后进行异基因SCT可获得满意的EFS，尽管存在晚期孤立性髓外复发的显著风险。
