Critical issues in autologous bone marrow transplantation in adult acute leukemia
Critical issues in autologous bone marrow transplantation in adult acute leukemia
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成人急性白血病自体骨髓移植的关键问题
DOI：
10.1111/j.1600-0609.1987.tb00739.x
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发表时间：
1987
影响因子：
3.1
通讯作者：
A. Zander
中科院分区：
文献类型：
--
作者：
M. Beran;A. Zander
背景成人急性髓细胞白血病(AML)和急性淋巴细胞白血病(ALL)是对化疗药物高度敏感的恶性肿瘤。在急性髓细胞白血病中，完全缓解率可达到70%至80%(1-4)；然而，与ALL一样，大多数患者通常在首次化疗后1年内死于复发疾病。获得完全缓解(CR)的AML患者5年(5-6)的长期存活率约为20%。在治疗方案中加入较新的药物，如4‘(9-吖啶胺甲基磺酸甘露糖)(MAMSA)、依托泊苷(VP-16)和5-氮胞苷，以及更有效地使用较老的药物，如大剂量阿糖胞苷(Ara-C)，仅产生轻微的改善。在以巩固和早期或晚期强化治疗的形式进行诱导治疗后，积极的治疗方法尚未显示出重大的生存改善。虽然最近的研究表明，缓解早期强化治疗可提高存活率(7-9)，但晚期强化治疗延长了中位缓解时间，但不影响患者的痊愈率(1011)。由于后勤方面的原因，晚期强化治疗选择的是长期处于持续完全缓解状态的患者，因此治愈的机会更大。大多数评估维持化疗长期作用的研究表明，维持化疗充其量对缓解期有积极影响，但到目前为止，它对生存率和治愈率(12-18)没有令人信服的影响。成人ALL的长期结果也很令人沮丧，尽管在最近的研究中，它似乎略好于AML。采用强化诱导化疗和周期维持疗法的治疗策略，以及长期给予积极化疗的交替方案，已经产生了近40%的长期无病存活率(19，20)。耐药白血病细胞群的出现导致复发和对治疗无效的疾病，最常被归咎于治疗失败。用放射和某些药物治疗血液动物肿瘤的研究表明，存在明确且往往陡峭的剂量-反应曲线(21-23)。对这些现象的认识导致了大剂量化疗和放射治疗的应用。耐药性可以通过单独增加化疗剂量(24)或联合超致死全身照射来克服。
Background Adult acute myeloblastic leukemia (AML) and acute lymphoblastic leukemia (ALL) are malignancies with great primary sensitivity to chemotherapeutic agents. In AML, a complete remission rate of 70% to 80% can be obtained (1-4); however, as with ALL, most patients usually die of recurrent disease within 1 yr of initial chemotherapy. The long-term survival of AML patients who achieve complete remission (CR) is about 20% at 5 yr (5-6). The addition of newer drugs such as 4’(9-acridinylaminomethanesulfon-manisidide) (mAMSA), etoposide (VP-16), and 5-azacytidine to the treatment regimens and the more effective use of older agents, e.g. high-dose cytosine arabinoside (Ara-C), have yielded only marginal improvements. Aggressive treatment approaches after induction therapy in the form of consolidation and early or late intensification of treatment have yet to demonstrate major survival improvements. Although recent studies suggest that early intensification of treatment in remission improves survival (7-9), late intensification has prolonged median remission duration but has not influenced the percentage of patients cured (1011). Because of logistics, late intensification selects patients who are in a continuous complete remission for a prolonged time period and therefore have a greater chance of being cured. Most studies evaluating the role of maintenance chemotherapy over an extended period of time indicate that, at best, it has a positive effect on remission duration but so far it shows no convincing effect on the survival and cure rate (12-18). The long-term outcome of adult ALL has also been dismal, though in most recent studies it appears somewhat better than that of AML. Treatment strategies employing intensive induction chemotherapy with cycling maintenance therapy and alternate regimens of aggressive chemotherapy given over prolonged periods of time have yielded long-term disease-free survival of close to 40% (19, 20). The emergence of therapy-resistant leukemic cell populations, which results in relapse and disease that does not respond to therapy, is most often blamed for therapy failure. Studies with hematological animal tumors treated with radiation and certain drugs have shown that a definite and often steep dose-response curve exists (21-23). Recognition of these phenomena led to the application of high-dose chemoand radiotherapy. Resistance can be overcome by escalation of the dose of chemotherapy alone (24) or in conjunction with supralethal total body irradia-
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Percoll 梯度分离骨髓的临床应用。
影响因子：
4.8
作者：
Jagannath,S;Reading,CL;Dicke,KA;Tindle,S;Devaraj,B;Tucker,SL;Spitzer,G
通讯作者：
Spitzer,G
急性淋巴细胞白血病第二次或后续缓解患者的自体骨髓移植：单克隆抗体 BA-1、BA-2 和 BA-3 加补体治疗骨髓的结果。
影响因子：
20.3
作者：
Ramsay,N;LeBien,T;Nesbit,M;McGlave,P;Weisdorf,D;Kenyon,P;Hurd,D;Goldman,A;Kim,T;Kersey,J
通讯作者：
Kersey,J
DOI：
10.1016/s0308-2261(86)80003-0
发表时间：
1986
期刊：
Clinics in haematology
影响因子：
--
作者：
Appelbaum,FR;Buckner,CD
通讯作者：
Buckner,CD
影响因子：
158.5
作者：
WEIDEN, PL;SULLIVAN, KM;THOMAS, ED
通讯作者：
THOMAS, ED
急性白血病自体骨髓移植：用 4-氢过氧环磷酰胺体外治疗骨髓清除肿瘤细胞的 I 期研究。
影响因子：
20.3
作者：
Kaizer,H;Stuart,RK;Brookmeyer,R;Beschorner,WE;Braine,HG;Burns,WH;Fuller,DJ;Korbling,M;Mangan,KF;Saral,R
通讯作者：
Saral,R