MARROW TRANSPLANTATION FOR ACUTE NONLYMPHOCYTIC LEUKEMIA AFTER TREATMENT WITH BUSULFAN AND CYCLOPHOSPHAMIDE
MARROW TRANSPLANTATION FOR ACUTE NONLYMPHOCYTIC LEUKEMIA AFTER TREATMENT WITH BUSULFAN AND CYCLOPHOSPHAMIDE
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DOI：
10.1056/nejm198312013092202
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发表时间：
1983-01-01
影响因子：
158.5
通讯作者：
YEAGER, AM
中科院分区：
文献类型：
--
作者：
SANTOS, GW;TUTSCHKA, PJ;YEAGER, AM
急性非淋巴细胞白血病患者（51例）（16例为终末期疾病，17例为第2或第3次缓解或早期复发，18例为第1次缓解）在用大剂量白消安和环磷酰胺进行细胞减灭后输注HLA相同的同胞骨髓。精算2年生存率分别为0%、29%和44%。12例患者仍存活，并在327-1488天后缓解，10例存活超过2年。急性移植物vs.宿主病和病毒性肺炎是主要死因。1例终末期白血病患者的白血病细胞未能清除，另1例脑膜白血病复发。仅观察到1例其他复发（在第3次缓解期间接受移植的患者中）。年龄较小和第一次缓解期移植对生存率有有利影响。大剂量白消安和环磷酰胺联合化疗后行异基因骨髓移植，可使急性白血病获得长期缓解。移植前大剂量白消安和环磷酰胺联合化疗是治疗急性非淋巴细胞白血病的一种有效方法。
Patients (51) with acute nonlymphocytic leukemia (16 with end-stage disease, 17 in 2nd or 3rd remission or in early relapse, and 18 in 1st remission) were given infusions of HLA-identical sibling bone marrow after cytoreduction with high doses of busulfan and cyclophosphamide. Actuarial 2 yr survival rates were 0%, 29% and 44%, respectively. Twelve patients are still alive and in remission after 327-1488 days, with 10 surviving beyond 2 yr. Acute graft-vs.-host disease and viral pneumonia were the major causes of death. Leukemic cells failed to clear in 1 patient with end-stage disease; a relapse with meningeal leukemia occurred in another. Only 1 other relapse was seen (in a patient given a transplant during a 3rd remission). Survival was favorably affected by younger age and tranplantation during 1st remission. High-dose chemotherapy with busulfan and cyclophosphamide, followed by allogeneic marrow transplantation, can apparently produce long-term remission of acute leukemia. Chemotherapy with high-dose busulfan and cyclophosphamide before transplantation provides an effective alternative to cyclophosphamide and total-body irradiation before transplantation for the treatment of acute nonlymphocytic leukemia.