One hundred patients with acute leukemia treated by chemotherapy, total body irradiation, and allogeneic marrow transplantation.
One hundred patients with acute leukemia treated by chemotherapy, total body irradiation, and allogeneic marrow transplantation.
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一百名急性白血病患者接受化疗、全身照射和同种异体骨髓移植治疗。
DOI：
10.1182/blood.v49.4.511.511
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发表时间：
1977
期刊：
影响因子：
20.3
通讯作者：
P. Weiden
中科院分区：
文献类型：
--
作者：
Thomas Ed;Buckner Cd;M. Banaji;R. Clift;A. Fefer;N. Flournoy;B. Goodell;R. Hickman;Lerner Kg;P. Neiman;G. Sale;J. Sanders;J. Singer;M. Stevens;R. Storb;P. Weiden
100例急性髓细胞白血病（AML）和急性淋巴细胞白血病（ALL）患者，在联合化疗后被认为是在他们的疾病的终末期进行了骨髓移植治疗。所有患者在接受1000拉德全身照射（TBI）后接受HLA相同同胞的骨髓移植。一组43例患者在TBI前2天、5天和4天分别给予环磷酰胺（CY）60 mg/kg。在第二组31例患者中，在CY和TBI之前给予额外的化疗。在第三组19名患者中，在CY和TBI之前给予BCNU。第四组7例患者在TBI前接受其他化疗方案。6例患者在骨髓输注后3-17天死亡，无植入证据。94名患者接受了移植，只有1名患者出现移植物排斥。13例患者存活，骨髓移植，没有维持抗白血病治疗，移植后1-4 1/2年没有复发白血病。3例患有慢性移植物抗宿主病（GVHD）。4例患者在移植后存活1 1/2 - 3 1/2年，但白血病复发。在93名可评估患者中，19名未发生GVHD，24名发生非常轻度的GVHD。50例患者发生中度至重度GVHD，其中40例接受抗胸腺细胞球蛋白治疗。54例患者发生间质性肺炎，是34例患者死亡的主要原因。间质性肺炎常与GVHD相关，最常见的病原体是巨细胞病毒。共有31名患者白血病复发。白血病复发与有无GVHD无明显相关性。复发率似乎是相对稳定的前2年，并在此之后的时间是非常低的。无论是生存率还是白血病复发似乎都不受白血病类型的影响，也不受TBI前给予的准备性化疗方案的影响。移植时临床状况良好的患者的生存时间明显长于临床状况不佳的患者（p = 0.001）。这一观察结果，再加上观察到，一些患者可能治愈他们的疾病，表明骨髓移植，现在应该进行更早的管理急性白血病患者谁有一个HLA匹配的同胞骨髓供体。
One hundred patients, 54 with acute myelogenous leukemia (AML) and 46 with acute lymphoblastic leukemia (ALL), considered to be in the end stages of their disease, after combination chemotherapy were treated by marrow transplantation. All patients were given a marrow graft from an HLA-identical sibling after receiving 1000-rad total body irradiation (TBI). One group of 43 patients was given cyclophosphamide (CY), 60 mg/kg on each of 2 days, 5 and 4 days before TBI. In a second group of 31 patients, additional chemotherapy was given before CY and TBI. In a third group of 19 patients, BCNU was given before CY and TBI. A fourth group of 7 patients received other chemotherapy regimens before TBI. Six patients died 3-17 days after marrow infusion without evidence of engraftment. Ninety-four patients were engrafted and only one patient rejected the graft. Thirteen patients are alive with a marrow graft, on no maintenance antileukemic therapy, and without recurrent leukemia 1-4 1/2 yr after transplantation. Three have chronic graft-versus-host disease (GVHD). Four patients are alive 1 1/2 - 3 1/2 yr after grafting but have had a relapse of their leukemia. Of 93 evaluable patients, 19 did not develop GVHD and 24 developed very mild GVHD. Fifty patients developed moderate to severe GVHD, and 40 of these were treated with antithymocyte globulin. Interstitial pneumonia occurred in 54 patients and was the primary cause of death in 34. Interstitial pneumonia often occurred in association with GVHD and the most common etiologic agent was cytomegalovirus. A total of 31 patients have had a relapse of leukemia. There was no definite correlation between relapse of leukemia and the presence or absence of GVHD. The relapse rate appeared to be relatively constant over the first 2 yr and was extremely low after that time. Neither survival nor leukemic relapse appeared to be influenced by the type of leukemia nor by the preparative chemotherapy regimen given before TBI. Patients in fair clinical condition at the time of transplantation showed significantly longer survival times than patients in poor condition (p = 0.001). This observation, coupled with the observation that some patients may be cured of their disease, indicates that marrow transplantation should now be undertaken earlier in the management of patients with acute leukemia who have an HLA-matched sibling marrow donor.