Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Effect of Cytarabine, Melphalan, and Total Body Irradiation as Conditioning for Autologous Stem Cell Transplantation for Patients with AML in First Remission

1차 관해된 급성 골수성 백혈병에서 자가 조혈모세포 이식을 위한 Cytarabine, Melphalan, 전신 방사선치료의 효과

  • Kang Ki Mun (Department of Therapeutic Radiology, Gyeongsang National University) ;
  • Choi Byung Ock (Department of Radiation Oncology, The Catholic University) ;
  • Chai Gyu Young (Gyeongsang Institute of Health Sciences) ;
  • Kang Young Nam (Department of Radiation Oncology, The Catholic University) ;
  • Jang Hong Sek (Department of Radiation Oncology, The Catholic University) ;
  • Kim Hee Jae (The Catholic Hematopoietic Stem Cell Transplantation Center) ;
  • Min Wo Sung (The Catholic Hematopoietic Stem Cell Transplantation Center) ;
  • Kim Chun Choo (The Catholic Hematopoietic Stem Cell Transplantation Center) ;
  • Choi Ihl Bohng (The Catholic Hematopoietic Stem Cell Transplantation Center)
  • 강기문 (경상대학교 의과대학 치료방사선과) ;
  • 최병옥 (가톨릭대학교 의과대학 방사선종양학교실) ;
  • 채규영 (경상대학교 건강과학연구원) ;
  • 강영남 (가톨릭대학교 의과대학 방사선종양학교실) ;
  • 장홍석 (가톨릭대학교 의과대학 방사선종양학교실) ;
  • 김희제 (가톨릭조혈모세포이식센터) ;
  • 민우성 (가톨릭조혈모세포이식센터) ;
  • 김춘추 (가톨릭조혈모세포이식센터) ;
  • 최일봉 (가톨릭대학교 의과대학 방사선종양학교실)
  • Published : 2003.09.01
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Abstract

Purpose: Current results of autologous stem cell transplantation (SCT) suggest that this procedure may prolong disease free survival In patients with acute myeloid leukemia (AML). Autologous SCT is increasingly used as treatment for AML in first remission. The aim of this study was to evaluate the outcome of autologous SCT for patients with AML in first remission treated by autologous SCT using cytarabine, melphalan and total body irradiation (TBI) as the conditioning regimen. Materials and Methods: Between January 1995 and December 1999, 29 patients with AML in first remission underwent autologous SCT. The median age of patients was 33 years (range, 16 to 47). The conditioning regimen consisted of cytarabine ($3.0\;gm/m^2$ for 3 days), melphalan ($100\;gm/m^2$ for 1 day) and TBI (total 1000 cGy in five fractions over 3 days). Results: The median follow up was 40 months with a range of 3 to 58 months. The 4-year cumulative probability of disease free survival was 69.0%, and median survival was 41.5 months. The 4-year relapse rate was 27.6%. The factor Influencing disease free survival and relapse rate was the French-American-British (FAB) classification ($M_3$ group vs. other groups; p=0.048, p=0.043). One patient died from treatment-related toxicity. Conclusion:: Although the small number of patients does not allow us to draw any firm conclusion, our results were encouraging and suggest that the association of cytarabine, melphalan and TBI as a conditioning regimen for autologous SCT for AML on first remission appears to be safe and effective.

목적: 급성 골수성 백혈병에서 자가 조혈모세포 이식은 무병생존율에 도움을 주며 1차 관해된 급성 골수성 백혈병에서 자가 조혈모세포 이식은 점차 늘어나고 있는 추세이다. 본 연구는 1차 관해된 급성 골수성 백혈병에서 자가 조혈모세포 이식을 위한 전처치 요법으로 cytarabine, melphalan과 전신 방사선치료를 시행하여 그 효과를 알아보고자 하였다. 대상 및 방법: 1995년 1월부터 1999년 12월까지 급성 골수성 백혈병으로 1차 관해 후 자가 조혈모세포 이식을 받은 29명을 대상으로 하였다. 환자의 중앙연령은 33세(16~47세)이었다. 자가 조혈모세포 이식을 위한 전처치 요법은 cytarabine ($3.0\;gm/m^2$, 3일), melphalan ($100\;gm/m^2$, 1일)과 전신 방사선치료를 시행하였다. 전신 방사선치료는 6MV 선형가속기를 이용하여 200 cGy를 1일 2회씩 5회 분할 조사하여 총 조사선량은 1000 cGy이었다. 결과: 추적 관찰기간은 3~58개월이었으며 중앙값은 40개월이었다. 전체 환자의 4년 무병생존율은 69.0%이었으며 중앙생존기간은 41.5개월이었다. 4년 재발률은 27.6%이었다. 무병생존율과 재발률에 영향을 미치는 인자 분석에서는 FAB 분류만이 유의한 예후인자로 분석되었다($M_3$군 vs. $M_3$를 제외한 군; p=0.048, p=0.043). 대 상 환자 중 9명에서 사망하였으며 치료와 관련된 사망은 1명이었고 8명은 재발로 사망하였다. 결론: 1차 관해된 급성 골수성 백혈병에서 자가 조혈모세포 이식을 위한 melphalan, cytarabine과 전신 방사선치료는 비교적 효과적인 전처치 요법이었다.

Keywords

References

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