Autologous and allogeneic bone marrow transplantation for chronic lymphocytic leukemia: preliminary results.
Autologous and allogeneic bone marrow transplantation for chronic lymphocytic leukemia: preliminary results.
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自体和同种异体骨髓移植治疗慢性淋巴细胞白血病：初步结果。
DOI：
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发表时间：
1994
影响因子：
45.3
通讯作者：
S. Giralt
中科院分区：
文献类型：
--
作者：
I. Khouri;M. Keating;H. Vriesendorp;C. Reading;D. Przepiorka;Y. Huh;B. Andersson;K. V. Besien;R. Mehra;S. Giralt
目的
本研究旨在探讨大剂量放化疗联合自体或异基因骨髓移植治疗经氟达拉滨治疗后复发的晚期慢性淋巴细胞白血病(CLL)的可行性和疗效。
患者和方法
22例晚期CLL患者接受了大剂量环磷酰胺、全身照射和骨髓移植。11例复发的CLL患者接受了自体骨髓移植，骨髓采集是在氟达拉滨诱导的缓解期间进行的；在7名患者中，使用抗CD19单抗和免疫磁分离从自体骨髓中去除了白血病细胞。11名患者接受了异基因或同基因骨髓移植，其中7名患者患有难治性RAI III或IV期疾病。
结果
6例自体移植受者完全缓解(CR)，4例结节状CR(NCR)，1例部分缓解(PR)。其中2例复发于慢性淋巴细胞性白血病，3例发展为里希特氏转化。2例患者在形态缓解期复发免疫细胞减少症，其中1例死于巨细胞病毒肺炎。11名患者中有6名在骨髓移植后2至29个月内得到缓解。在接受异基因或同基因骨髓移植的11名患者中，7名患者获得了CR，2名患者获得了NCR，1名患者获得了PR；10名患者在骨髓移植后2至36个月存活。
结论
这些数据表明，大剂量化疗联合异基因骨髓移植在慢性淋巴细胞白血病患者中产生CRS是有效的。自体移植治疗慢性淋巴细胞性白血病是可行的，并且能够缓解晚期慢性淋巴细胞性白血病患者。有必要进一步研究以评估骨髓移植在慢性淋巴细胞性白血病治疗中的作用。
PURPOSE
This study was undertaken to evaluate the feasibility and therapeutic effect of high-dose chemoradiotherapy with autologous or allogeneic bone marrow transplantation (BMT) in patients with advanced chronic lymphocytic leukemia (CLL) who relapse after fludarabine treatment.
PATIENTS AND METHODS
Twenty-two patients with advanced CLL received high-dose cyclophosphamide, total-body irradiation, and BMT. Eleven patients with relapsed CLL received autologous BMT with marrow collected during a prior fludarabine-induced remission; leukemia cells were depleted from the autologous marrow in seven patients using an anti-CD19 monoclonal antibody and immunomagnetic separation. Eleven patients received allogeneic or syngeneic BMT, seven of whom had refractory Rai stage III or IV disease.
RESULTS
Six autologous transplant recipients achieved a complete remission (CR), four a nodular CR (nCR), and one a partial remission (PR). Two recurred with CLL, and three developed Richter's transformation. Two patients had recurrence of immune cytopenias while in morphologic remission; one of these patients died of cytomegalovirus pneumonia. Six of 11 patients survive in remission 2 to 29 months following BMT. Of the 11 patients who received allogeneic or syngeneic BMT, seven achieved a CR, two a nCR, and one a PR; 10 survive 2 to 36 months following BMT.
CONCLUSION
These data indicate that high-dose chemotherapy with allogeneic BMT is effective at producing CRs in patients with CLL. Autologous transplantation in CLL is feasible and is capable of producing remissions in patients with advanced CLL. Further studies are warranted to assess the role of BMT in the treatment of CLL.
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