激活骨髓自体移植治疗急性早幼粒细胞白血病

目的　探讨激活骨髓 (ABM)自体移植作为急性早幼粒细胞白血病 (APL)缓解后巩固强化治疗的意义。方法　 31例病人 ,第一次完全缓解 (CR1) 2 7例、CR2 3例、第二次复发部分缓解 (PR) 1例 ;移植预处理方案 :2 7例接受MACC(马法兰、阿糖胞苷、环磷酰胺、环己亚硝脲 )方案 ,5例用TBI +CY(全身放疗 +环磷酰胺 )方案 ;荧光原位杂交测定PML/RARα融合基因 ;用Kaplan Meier生存曲线评估移植后无病生存率 ,COX回归模型分析性别、PML/RARα阳性、移植前状态 (CR1与CR2和PR)、初治时白细胞 (WBC)和血小板 (PBC)值对无病生存的影响。结果　CR1病人移植后无一例复发 ,移植后无病生存期 3～ 113个月、中位无病生存期 4 6个月 ,5年无病生存率为 10 0 % ;CR2病人 1例于移植后 19个月复发 ,另 2例分别无病生存为 7与 4 8个月 ;PR患者在移植后获CR 8个月复发。移植后全部病人均获得造血重建 ,无一例死于移植相关并发症。多因素分析长生存与移植前状态相关 (P <0 .0 5 ) ,而与性别、PML/RARα阳性、初诊时WBC和PBC数无关 ;诱导缓解后PML/RARα阳性与初诊时WBC和PBC数相关。结论　激活骨髓自体移植治疗CR后的APL病人能降低复发率和提高无病生存率、尤是CR1后的APL病人。

Autologous transplantation of recombinant interleukine-2 activated bone marrow for acute promyelocytic leukemia

Objective To explore the benefit of autologous transplantation of interleukine 2 activated bone marrow (ABM) in acute promyelocytic leukemia (APL) as consolidation therapy. Methods 31 patients with APL, 27 in first complete remission (CR1), 3 in CR2, and 1 in partial remission (PR) after the second relapse, were treated with autologous transplantation of ABM. The conditioning regimens included MACC protocol (Melphalan, Ara C, CTX, and CCNU) in 26 patients and TBI+CY protocol in 5 patients. The PML/RARa fusion gene was measured by fluorescence in situ hybridization. Kaplan Meier survival analysis model was used to estimate the disease free survival (DFS) rate at 5 years post transplantation and COX regression model was used to analyze the DFS influencing factors, including sex, PML/RARa positive state, pre transplantation state (CR1, CR2, or PR), white blood cell (WBC) count, and platelet (PBC) count. Results The 27 patients in CR1 had a DFS time of 3 to 113 months (with a mean DFS time of 46 months), and a 5 year DFS rate of 100%; none of them suffered a relapse after transplantation. One of the 3 patients in CR2 relapsed in 19 months after the transplantation and the other two patients had been in DFS state for 7 and 33 months respectively. The patient in PR obtained CR and relapsed 8 months after the transplantation. All the patients showed reconstitution of hematopoiesis. None of the patients died of transplantation related complication. Multivariate analysis showed that long term survival was correlated with the pre transplantation statues and not with sex, positivity of PML/RARa, and WBC and PBC counts. Conclusion Autologous transplantation of ABM reduces the relapse and increases the long term survival in the patients with APL in CR, especially in CR1.