BONE-MARROW TRANSPLANTS FROM HLA-IDENTICAL SIBLINGS AS COMPARED WITH CHEMOTHERAPY FOR CHILDREN WITH ACUTE LYMPHOBLASTIC-LEUKEMIA IN A 2ND REMISSION
BONE-MARROW TRANSPLANTS FROM HLA-IDENTICAL SIBLINGS AS COMPARED WITH CHEMOTHERAPY FOR CHILDREN WITH ACUTE LYMPHOBLASTIC-LEUKEMIA IN A 2ND REMISSION
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DOI：
10.1056/nejm199411103311902
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发表时间：
1994-11-10
影响因子：
158.5
通讯作者：
GALE, RP
中科院分区：
文献类型：
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作者：
BARRETT, AJ;HOROWITZ, MM;GALE, RP
背景。目前尚不清楚如何最好地治疗骨髓复发后处于第二次缓解期的急性淋巴细胞白血病儿童。对于那些具有相同hla的兄弟姐妹，是否进行骨髓移植或继续化疗的问题还没有答案。我们比较了国际骨髓移植登记处报告的376名儿童接受hla相同的兄弟姐妹骨髓移植治疗的结果，以及儿科肿瘤组接受化疗治疗的540名儿童的结果。初步分析确定了两组患者治疗失败的相关变量。我们通过匹配这些变量来选择队列。通过选择匹配的配对来控制与缓解和治疗之间间隔差异相关的可能偏差，其中化疗受体的第二次缓解持续时间至少与移植受体的第二次缓解和移植之间的时间一样长。共研究了255对配对的配对。移植受者5年复发的平均（+/- SE）概率显著低于化疗受者（45 +/- 4% vs 80 +/- 3%, P < 0.001）。移植后5年无白血病生存率高于化疗后（40 +/- 3% vs. 17 +/- 3%, P < 0.001）。与化疗相比，移植的相对益处在预后因素表明复发风险高或低的儿童中是相似的（首次缓解的持续时间、年龄、诊断时的白细胞计数和白血病细胞的表型）。对于处于第二次缓解期的急性淋巴细胞白血病患儿，与化疗相比，来自hla相同的兄弟姐妹的骨髓移植可减少复发，延长无白血病生存期。
Background. It is unclear how best to treat children with acute lymphoblastic leukemia who are in a second remission after a bone marrow relapse. For those with HLA-identical siblings, the question of whether to perform a bone marrow transplantation or to continue chemotherapy has not been answered.Methods. We compared the results of treatment with marrow transplants from HLA-identical siblings in 376 children, as reported to the International Bone Marrow Transplant Registry, with the results of chemotherapy in 540 children treated by the Pediatric Oncology Group. A preliminary analysis identified variables associated with treatment failure in both groups. We selected cohorts by matching these variables. A possible bias associated with differences in the interval between remission and treatment was controlled for by choosing matched pairs in which the duration of the second remission in the chemotherapy recipient was at least as long as the time between the second remission and transplantation in the transplant recipient. A total of 255 matched pairs were studied.Results. The mean (+/- SE) probability of a relapse at five years was significantly lower among the transplant recipients than among the chemotherapy recipients (45 +/- 4 percent vs. 80 +/- 3 percent, P < 0.001). At five years the probability of leukemia-free survival was higher after transplantation than after chemotherapy (40 +/- 3 percent vs. 17 +/- 3 percent, P < 0.001). The relative benefit of transplantation as compared with chemotherapy was similar in children with prognostic factors indicating a high or low risk of relapse (the duration of the first remission, age, leukocyte count at the time of the diagnosis, and phenotype of the leukemic cells).Conclusions. For children with acute lymphoblastic leukemia in a second remission, bone marrow transplants from HLA-identical siblings result in fewer relapses and longer leukemia-free survival than does chemotherapy.