Allogeneic bone marrow transplantation for children with acute myeloblastic leukemia in first complete remission: impact of conditioning regimen without total-body irradiation--a report from the Société Française de Greffe de Moelle.
Allogeneic bone marrow transplantation for children with acute myeloblastic leukemia in first complete remission: impact of conditioning regimen without total-body irradiation--a report from the Société Française de Greffe de Moelle.
复制标题
首次完全缓解的急性髓细胞性白血病儿童的同种异体骨髓移植：不进行全身照射的预处理方案的影响——法国格雷夫德莫埃勒协会的报告。
DOI：
10.1200/jco.1994.12.6.1217
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发表时间：
1994
期刊：
影响因子：
--
通讯作者：
D. Maraninchi
中科院分区：
文献类型：
--
作者：
Gérard Michel;G. Socié;F. Gebhard;F. Bernaudin;Isabelle Thuret;J. Vannier;François Demeocq;G. Leverger;J. Pico;Hervé Rubie;F. Mechinaud;J. Reiffers;N. Gratecos;Xavier Troussard;Jouet Jp;G. Simonin;E. Gluckman;D. Maraninchi
目的
目的分析法国在人类白细胞抗原相合骨髓移植(BMT)治疗儿童急性髓细胞白血病(AML)首次完全缓解(CR)前化疗准备的经验。
患者和方法
这项研究使用的数据库是法国儿童急性髓系白血病的BMT登记。23例患儿给予丁硫丹+环磷酰胺120 mg/kg(Bu-Cy120组)。19只给予丁硫丹+环磷酰胺200 mg/kg(Bu-Cy200组)。同期32例患者接受全身照射(TBI组)，最常合并环磷酰胺120 mg/kg。
结果
Bu-Cy120组、Bu-Cy200组和TBI组的复发概率分别为54%、13%和10%(单变量分析中P<；0.05，对数等级检验，2 dF)。在多变量分析中，使用Bu-Cy120的预适应方案与较高的复发风险显著相关(P=0.02；相对风险3.62)。移植相关死亡率(TRM)在Bu-Cy120组为0%，Bu-Cy200组为5%，脑外伤组为10%。Kaplan-Meier估计的无事件生存率(EFS)分别为46%+/-24%、82%+/-18%和80%+/-14%，中位随访期分别为28个月(3~78个月)、31个月(4~68个月)和48个月(2~73个月)。在多变量分析中，有两个因素对EFS有不利影响：使用Bu-Cy120的调理方案(P=0.07)和从确诊到骨髓移植的较长时间(>；OR=120天，P=0.08)。
结论
BU-Cy120是一种耐受性良好的制剂，但对首次CR的AML儿童来说，导致复发的风险很高。当环磷酰胺的剂量增加到200毫克/公斤时，就不会观察到这种高复发风险。
PURPOSE
To analyze the French experience of chemotherapeutic preparation before human leukocyte antigen (HLA)-identical bone marrow transplantation (BMT) in children with acute myeloblastic leukemia (AML) in first complete remission (CR).
PATIENTS AND METHODS
The data base used for this study was a French BMT registry for childhood AML. Twenty-three children were conditioned with busulfan and 120 mg/kg cyclophosphamide (Bu-Cy 120 group). Nineteen received busulfan and 200 mg/kg cyclophosphamide (Bu-Cy200 group). During the same time period, 32 patients were prepared with total-body irradiation (TBI group) most often in combination with 120 mg/kg of cyclophosphamide.
RESULTS
The probability of relapse was 54%, 13%, and 10% for the Bu-Cy120, Bu-Cy200, and TBI groups, respectively (P < .05 in the univariate analysis, log-rank test, 2 df). In the multivariate analysis, a conditioning regimen with Bu-Cy120 was significantly associated with a higher risk of relapse (P = .02; relative risk, 3.62). The probability of transplant-related mortality (TRM) was 0% for Bu-Cy120, 5% for Bu-Cy200, and 10% for TBI. Kaplan-Meier estimations of event-free survival (EFS) were 46% +/- 24%, 82% +/- 18%, and 80% +/- 14%, respectively, for the three groups, with median follow-up durations of 28 months (range, 3 to 78), 31 months (4 to 68), and 48 months (2 to 73). In the multivariate analysis, two factors adversely affected EFS: a conditioning regimen with Bu-Cy120 (P = .07) and a long interval from diagnosis to BMT (> or = 120 days, P = .08).
CONCLUSION
Bu-Cy120 is a well-tolerated preparation, but results in a high risk of relapse for children with AML in first CR. This high risk of relapse is not observed when the dose of cyclophosphamide is increased to 200 mg/kg.