Outcomes after HLA-matched sibling transplantation or chemotherapy in children with B-precursor acute lymphoblastic leukemia in a second remission: a collaborative study of the Children's Oncology Group and the Center for International Blood and Marrow Transplant Research
Outcomes after HLA-matched sibling transplantation or chemotherapy in children with B-precursor acute lymphoblastic leukemia in a second remission: a collaborative study of the Children's Oncology Group and the Center for International Blood and Marrow Transplant Research
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DOI：
10.1182/blood-2005-12-4942
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发表时间：
2006-06-15
期刊：
影响因子：
20.3
通讯作者：
Davies, SM
中科院分区：
文献类型：
--
作者：
Eapen, M;Raetz, E;Davies, SM
对于骨髓复发后第二次临床缓解（CR）的B前体急性淋巴细胞白血病（ALL）儿童的最佳治疗方法存在争议。为了解决这个问题，我们比较了1991年至1997年期间188例参加化疗试验的患者和186例HLA匹配的同胞移植患者的结果。两组相似，除了化疗受者更年轻（中位年龄为5岁对8岁），骨髓和髓外复发的可能性更小（19%对30%）。为了调整移植时间偏倚，使用左截断考克斯回归模型比较治疗结局。化疗和移植的相对疗效取决于从诊断到首次复发的时间和所用的移植预处理方案。对于早期第一次复发的儿童（< 36个月），接受全身照射（TBI）的移植方案后第二次复发的风险显著低于化疗方案（相对风险[RR]，0.49; 95%置信区间[CI] 0.33-0.71，P <0.001）。相反，对于晚期首次复发（>= 36个月）的儿童，含TBI方案和化疗后第二次复发的风险相似（FIR，0.92; 95%CI，0.49-1.70，P = 0.78）。这些数据支持在ALL和早期复发儿童的第二次CR中使用含TBI的方案进行HLA匹配的同胞供体移植。
The best treatment approach for children with B-precursor acute lymphoblastic leukemia (ALL) in second clinical remission (CR) after a marrow relapse is controversial. To address this question, we compared outcomes in 188 patients enrolled in chemotherapy trials and 186 HLA-matched sibling transplants, treated between 1991 and 1997. Groups were similar except that chemotherapy recipients were younger (median age, 5 versus 8 years) and less likely to have combined marrow and extramedullary relapse (19% versus 30%). To adjust for time-to-transplant bias, treatment outcomes were compared using left-truncated Cox regression models. The relative efficacy of chemotherapy and transplantation depended on time from diagnosis to first relapse and the transplant conditioning regimen used. For children with early first relapse (< 36 months), risk of a second relapse was significantly lower after total body irradiation (TBI)-containing transplant regimens (relative risk [RR], 0.49; 95% confidence interval [CI] 0.33-0.71, P < .001) than chemotherapy regimens. In contrast, for children with a late first relapse (>= 36 months), risks of second relapse were similar after TBI-containing regimens and chemotherapy (FIR, 0.92; 95% CI, 0.49-1.70, P = .78). These data support HLA-matched sibling donor transplantation using a TBI-containing regimen in second CR for children with ALL and early relapse.