Bone Marrow Transplantation for Childhood Acute Myelogenous Leukemia

骨髓移植治療急性骨髓性白血病

林凱信(Kai-Hsin Lin) ； 周獻堂(Shiann-Tarng Jou) ； 陳榮隆(Rong-Long Chen) ； 林東燦(Dong-Tsamn Lin) ； 林國信(Kuo-Sin Lin)

《Acta Paediatrica Sinica》 35卷5期 (1994/10) Pp. 415-422

https://doi.org/10.7097/APS.199410.0415

摘要

從1987至1992年間，共有六位急性骨髓性白血病孩童於本院小兒科接受骨髓移植(BMT)治療。四位接受組織抗原相符合的史弟姐妹捐獻的骨髓，另外兩們接受單套組織抗原符合的父親捐獻的骨髓。四位BMT是在第一次完全緩解(CR)時進行，另兩位是在第二次CR和早期復發時進行。BMT之前，四位接受busulfan 16 mg/kg和cyclophosphamide 120 mg/kg (BUCY 2)為先前化學調理治療，另外兩們則以busulfan 16mg/kg和cyclophosphamide 200　mg/kg (BUCY 4)為調理治療。預防植體抗宿病(GVHD)，則使用cyclosporine加上四劑methotrexate。所有的病童移植成功且達到CR；其中有三位於BMT後持續無病存活達10、20和59個月以上，另外三位病童中，一位接受父親的骨髓達到CR五個月後復發，一位也是接受父親的骨髓達到CR，三個月變成再生不良性貧血，最後一例於BMT達到CR四個月後復發，這位病童接受第二次BMT，但死於併發症。急性GVHD發生於兩位病童，而其中一位有慢性GVHD。接受BUCY 2的病童，除一位有輕微肝靜阻塞病之外，少有毒性發生。接受BUCY 4的兩位病童，有一例發生出血性膀胱炎。這些結果顯示，BUCY 2用來準備急性骨髓性白血病病人進行BMT毒性小，第一次CR時進行BMT成果較好，第一次以上CR或復發時以及組織抗原不全符合時的BMT，都會增加BMT失敗及白血病復發的危險。同一個病人接受第二次BMT，通常不成功。

關鍵字

急性骨髓性白血病 ； 骨髓移植 ； 移植物抗宿主病 ； busulfan ； cyclophosphamide ； 二度骨髓移植 ； filgrastim ； molgramostim

並列摘要

Six consecutive patients with acute myelogenous leukemia (AML) underwent 7 allogeneic bone marrow transplants at National Taiwan University Hospital. Marrow ablation for 4 patients consisted of busulfan 16 mg/kg and cyclophosphamide 120 mg/kg (BUCY 2). Two patients had busulfan 16 mg/kg and cyclophosphamide 200 mg/kg (BUCY 4) as marrow ablation. One had a second transplant following cytosine arabinoside 3 gin/m^2/dose×10 doses plus total body irradiation 12 Gy. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine and short course methotrexate. Four patients received marrow from their HLA compatible siblings and two from their HLA-haplotype-matched fathers. Four transplants were performed during first remission and the other three during subsequent remission or relapse. All patients except one engrafted and achieved a complete remission (CR). Three of 4 patients transplanted in first CR are alive for over 10, 20 and 59 months respectively after transplant. One of the two patients who each received marrow from their fathers during 2nd CR and relapse, developed relapse 5 months later and the other developed aplasia 3 months later. Acute GVHD occurred in two of six patients. Localized chronic GVHD occurred in one of these two patients. Toxicities of BUCY 2 were minimal except veno-occlusive disease. One patient who received BUCY 4 developed hemorrhagic cystitis. There were no treatment related deaths except one patient who received 2nd transplant. These results demonstrate that BUCY 2 should be considered as a preparative regimen for allogeneic bone marrow transplantation for patients with AML in first remission. Subsequent remission or relapse and HLA-mismatching increases the risk of graft failure and leukemia relapse. Second transplantation is usually unsuccessful.

並列關鍵字

AML ； ANLL ； BMT ； busulfan ； cyclophosphamide ； GVHD ； 2nd BMT ； filgrastim ； molgramostim