化疗与自体或异基因骨髓移植在初治缓解期急性髓系白血病治疗中的比较。

Chemotherapy compared with autologous or allogeneic bone marrow transplantation in the management of acute myeloid leukemia in first remission.

作者信息

Cassileth P A, Harrington D P, Appelbaum F R, Lazarus H M, Rowe J M, Paietta E, Willman C, Hurd D D, Bennett J M, Blume K G, Head D R, Wiernik P H

机构信息

University of Miami Sylvester Comprehensive Cancer Center, FL 33136, USA.

出版信息

N Engl J Med. 1998 Dec 3;339(23):1649-56. doi: 10.1056/NEJM199812033392301.

DOI:10.1056/NEJM199812033392301

PMID:9834301

Abstract

BACKGROUND

In young adults with acute myeloid leukemia, intensive chemotherapy during the initial remission improves the long-term outcome, but the role of bone marrow transplantation is uncertain. We compared high-dose cytarabine with autologous or allogeneic marrow transplantation during the first remission of acute myeloid leukemia.

METHODS

Previously untreated adolescents and adults 16 to 55 years of age who had acute myeloid leukemia received standard induction chemotherapy. After complete remission had been achieved, idarubicin (two days) and cytarabine (five days) were administered. Patients with histocompatible siblings were offered allogeneic marrow transplantation, whereas the remaining patients were randomly assigned to receive a single course of high-dose cytarabine or transplantation of autologous marrow treated with perfosfamide (4-hydroperoxycyclophosphamide). Oral busulfan and intravenous cyclophosphamide were used as preparative regimens for both allogeneic and autologous marrow transplantation. The end points were survival from the time of complete remission and disease-free survival.

RESULTS

In an intention-to-treat analysis, we found no significant differences in disease-free survival among patients receiving high-dose chemotherapy, those undergoing autologous bone marrow transplantation, and those undergoing allogeneic marrow transplantation. The median follow-up was four years. Survival after complete remission was somewhat better after chemotherapy than after autologous marrow transplantation (P=0.05). There was a marginal advantage in terms of overall survival with chemotherapy as compared with allogeneic marrow transplantation (P=0.04).

CONCLUSIONS

A postinduction course of high-dose cytarabine can provide equivalent disease-free survival and somewhat better overall survival than autologous marrow transplantation in adults with acute myeloid leukemia.

摘要

背景

在年轻的急性髓系白血病患者中，初始缓解期进行强化化疗可改善长期预后，但骨髓移植的作用尚不确定。我们比较了大剂量阿糖胞苷与急性髓系白血病首次缓解期自体或异基因骨髓移植的疗效。

方法

16至55岁未经治疗的急性髓系白血病青少年和成人接受标准诱导化疗。完全缓解后，给予去甲氧柔红霉素（两天）和阿糖胞苷（五天）。有组织相容性同胞供者的患者接受异基因骨髓移植，其余患者随机分配接受单疗程大剂量阿糖胞苷或用4-羟环磷酰胺处理的自体骨髓移植。口服白消安和静脉注射环磷酰胺用作异基因和自体骨髓移植的预处理方案。终点指标为完全缓解后的生存期和无病生存期。