Chemotherapy compared with autologous or allogeneic bone marrow transplantation in the management of acute myeloid leukemia in first remission
Chemotherapy compared with autologous or allogeneic bone marrow transplantation in the management of acute myeloid leukemia in first remission
复制标题
DOI：
10.1056/nejm199812033392301
复制
发表时间：
1998-12-03
影响因子：
158.5
通讯作者：
Wiernik, PH
中科院分区：
文献类型：
--
作者：
Cassileth, PA;Harrington, DP;Wiernik, PH
在年轻成人急性髓性白血病患者中，在缓解期加强化疗可改善长期预后，但骨髓移植的作用尚不确定。我们比较了高剂量阿糖胞苷与自体或异基因骨髓移植在第一次缓解急性髓细胞白血病。方法以前未经治疗的青少年和成人16至55岁的急性髓细胞白血病接受标准诱导化疗。达到完全缓解后，给予依达鲁肽（2天）和阿糖胞苷（5天）。对具有组织相容性兄弟姐妹的患者进行异基因骨髓移植，而其余患者随机分配接受单疗程高剂量阿糖胞苷或自体骨髓移植，并接受perfosfamide（4-hydroperoxycyclophosphamide）治疗。口服白消安和静脉注射环磷酰胺被用作同种异体和自体骨髓移植的准备方案。结果在意向治疗分析中，我们发现接受大剂量化疗的患者，接受自体骨髓移植的患者和接受异基因骨髓移植的患者之间的无病生存率没有显着差异。中位随访时间为4年。化疗后完全缓解后的生存率略高于自体骨髓移植（P = 0.05）。有一个边际优势，在总生存期与化疗相比，异基因骨髓移植（P = 0.04）。结论诱导后的过程中，高剂量阿糖胞苷可以提供等效的无病生存期和更好的总生存期比自体骨髓移植在成人急性髓系白血病。（N Engl J Med 1998;339：1649-56.）（C）1998年，马萨诸塞州医学会。
Background In young adults with acute myeloid leukemia, intensive chemotherapy during the initial remission improves the long-term outcome, but the role of bone marrow transplantation is uncertain. We compared high-dose cytarabine with autologous or allogeneic marrow transplantation during the first remission of acute myeloid leukemia.Methods Previously untreated adolescents and adults 16 to 55 years of age who had acute myeloid leukemia received standard induction chemotherapy. After complete remission had been achieved, idarubicin (two days) and cytarabine (five days) were administered. Patients with histocompatible siblings were offered allogeneic marrow transplantation, whereas the remaining patients were randomly assigned to receive a single course of high-dose cytarabine or transplantation of autologous marrow treated with perfosfamide (4-hydroperoxycyclophosphamide). Oral busulfan and intravenous cyclophosphamide were used as preparative regimens for both allogeneic and autologous marrow transplantation. The end points were survival from the time of complete remission and disease-free survival.Results In an intention-to-treat analysis, we found no significant differences in disease-free survival among patients receiving high-dose chemotherapy, those undergoing autologous bone marrow transplantation, and those undergoing allogeneic marrow transplantation. The median follow-up was four years. Survival after complete remission was somewhat better after chemotherapy than after autologous marrow transplantation (P = 0.05). There was a marginal advantage in terms of overall survival with chemotherapy as compared with allogeneic marrow transplantation (P = 0.04).Conclusions A postinduction course of high-dose cytarabine can provide equivalent disease-free survival and somewhat better overall survival than autologous marrow transplantation in adults with acute myeloid leukemia. (N Engl J Med 1998;339:1649-56.) (C)1998, Massachusetts Medical Society.