동종 골수이식에 의한 만성 골수성 백혈병의 치료

Objectives: We report the results of 11 patients with chronic myelogenous leukemia treated with allogeneic bone marrow transplantation using marrow cells from HLA-identical sibling donors, Methods: Patients with chronic myelogenous leukemia less than 40 years of age were eligible for study entry. Bone marrow donors were HLA-identical siblings. The conditioning regimens consisted of busulfan plus cyclophosphamide or cyclophosphamide plus total body irradiation, and cyclosporin-A was given to pre- vent graft-versus-host disease. Patients were managed in reverse isolation and received oral gut decontamination. Supportive cares such as transfusion and empirical antibiotics were done. Results: Seven patients were male, and four female. Median age was 27 years (range 18-36 years), and nine patients were in chronic phase at the time of transplantation, and two patients in accelerated phase. Donors had a median age of 35 years (range 15-42 years): two were male, and nine female. Median interval from diagnosis to transplantation was 13 months (range 3-26 months). Median duration of severe neutropenia (neutrophil < 0.5 x 10"/L) was 20 days (range 16-42 days). Six patients developed grade I-II acute graft-versus- host-disease, mainly involving the skin. Four patients developed chronic graft-versus-host-disease, which mainly involved oral mucosa and skin. Four patients relapsed cytogenetically within 12 months posttransplant. Five patients developed infections within 30 days posttransplant, three had pneumocystis carinii pneumonia after 100 days posttransplant. Six patients were alive after median follow-up of 25 months, and the median leukemia-free survival of all patients was 6 months (range 3.5-75 months). Three patients died from relapse, and two from interstitial pneumonitis. Conclusion: This report confirms high probability of the cure of chronic myelogenous leukemia with allogeneic bone marrow transplantation, especially in chronic phase, and showed milder complications associated with transplantation than previous reports.