Allogeneic hematopoietic cell transplantation for patients with high-risk acute lymphoblastic leukemia in first or second complete remission using fractionated total-body irradiation and high-dose etoposide: A 15-year experience
Allogeneic hematopoietic cell transplantation for patients with high-risk acute lymphoblastic leukemia in first or second complete remission using fractionated total-body irradiation and high-dose etoposide: A 15-year experience
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DOI：
10.1016/s0301-472x(03)00231-5
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发表时间：
2003-10-01
影响因子：
2.6
通讯作者：
Blume, KG
中科院分区：
文献类型：
--
作者：
Jamieson, CHM;Amylon, MD;Blume, KG
Objective.这项回顾性研究的基本原理是确定长期总体和无事件生存率，复发，高危儿童和成人急性淋巴细胞白血病（ALL）首次（CR 1）和第二次缓解（CR2）患者接受由分次全身照射（FTBI）和大剂量依托泊苷（VP-16）组成的单一预备方案治疗后的治疗相关死亡率在异基因造血细胞移植之前。患者和方法。在斯坦福大学医学中心的15年期间，连续85例高危儿科患者（17岁以下; n = 41）和成人（年龄18-55岁; n = 44）; CR 1（n = 55）和CR2（n = 30）的白血病（ALL）患者在接受FTBI治疗后接受HLA匹配的同胞异基因骨髓或外周血祖细胞移植（1，320 cGy）和高剂量VP-16（60 mg/kg）作为其预备方案。大多数CR 1移植患者（n = 45）具有高风险特征，包括年龄超过30岁，就诊时白色血细胞计数超过25，000/穆尔，髓外疾病，需要超过4周的诱导化疗以达到CR，或高风险染色体易位。CRI组移植患者多为成人（n = 39），而CR2组主要为儿童或青少年（n = 25）。CR 1患者（15% +/- 10%）的10年Kaplan-Meier复发估计值显著（p = 0.05）低于CR2患者（33% +/- 20%）。复发是CR2移植患者治疗失败的最常见原因。呈显著（p = 0.05）CRI中慢性移植物抗宿主病的发生率较高（32%+/-14%），与CR2相比（9% +/-11%）患者;然而，CR 1移植患者的总生存率（66% ± 14%）与CR2移植患者的总生存率（62% ± 19%）相当（p = 0.67）。CR 1（64% ± 14%）和CR2（61% ± 18%）患者的无事件生存率也相似（p = 0.53）。CR 1和CR2之间以及费城染色体（Ph）阳性（Ph+）和Ph-（p = 0.23）ALL患者之间的治疗相关死亡率相当（p = 0.51）。总体而言，FTBI/VP-16是一种高效的预备方案，可为CR 1或CR2中接受同种异体造血细胞移植治疗高危ALL的患者提供持久缓解。(C)2003年国际实验血液学学会。爱思唯尔公司出版
Objective. The rationale for this retrospective study was to identify the long-term overall and event-free survival, relapse, and treatment-related mortality rates of high-risk pediatric and adult first (CR1) and second remission (CR2) patients with acute lymphoblastic leukemia (ALL) who were treated with a single preparatory regimen consisting of fractionated total-body irradiation (FTBI) and high-dose etoposide (VP-16) prior to allogeneic hernatopoietic cell transplantation.Patients and Methods. Over a 15-year period at Stanford University Medical Center, 85 consecutive high-risk pediatric (up to age 17 years; n = 41) and adult (age 18-55 years; n = 44); patients with leukemia (ALL) in CR1 (n = 55) and CR2 (n = 30) received HLA-matched sibling allogeneic bone marrow or peripheral blood progenitor grafts after being treated with FTBI (1,320 cGy) and high-dose VP-16 (60 mg/kg) as their preparatory regimen. The majority of patients transplanted in CR1 (n = 45) had high-risk features, including age above 30 years, white blood cell count at presentation exceeding 25,000/muL, extramedullary disease, need for more than 4 weeks of induction chemotherapy to achieve CR, or high-risk chromosomal translocations. Most patients transplanted in CRI were adults (n = 39), whereas patients in CR2 were primarily children or adolescents (n = 25).Results. The 10-year Kaplan-Meier estimates of relapse were significantly (p = 0.05) lower in CR1 patients (15% +/- 10%) than in CR2 patients (33% +/- 20%). Relapse was the most common cause of treatment failure in patients transplanted in CR2. There was a significantly (p = 0.05) higher rate of chronic graft-vs-host disease in CRI (32 % +/- 14 %) compared with CR2 (9% +/- 11 %) patients; however, overall survival for patients transplanted in CR1 (66% +/- 14%) was comparable (p = 0.67) to that of patients transplanted in CR2 (62% +/- 19%). Event-free survival rates also were similar (p = 0.53) between CR1 (64 % 14 %) and CR2 (61 % +/- 18 %) patients. Treatment-related mortality rates were equivalent (p = 0.51) between CR1 and CR2, as well as between Philadelphia chromosome (Ph) positive (Ph+) and Ph- (p = 0.23) ALL patients.Conclusion. Overall, FTBI/VP-16 is a highly effective preparatory regimen that provides durable remissions for patients receiving allogeneic hematopoietic cell transplantation for high-risk ALL in CR1 or CR2. (C) 2003 International Society for Experimental Hematology. Published by Elsevier Inc.