Autologous blood cell transplantation versus HLA-identical sibling transplantation for acute myeloid leukemia in first complete remission: a registry study from the Center for International Blood and Marrow Transplantation Research
Autologous blood cell transplantation versus HLA-identical sibling transplantation for acute myeloid leukemia in first complete remission: a registry study from the Center for International Blood and Marrow Transplantation Research
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DOI：
10.3324/haematol.2012.062059
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发表时间：
2013-02-01
期刊：
影响因子：
10.1
通讯作者：
Weisdorf, Daniel J.
中科院分区：
文献类型：
--
作者：
Keating, Armand;DaSilva, Gisela;Weisdorf, Daniel J.
首次完全缓解的急性髓细胞白血病缓解后的最佳治疗方案仍不确定。以前对自体和异体造血细胞移植的比较发现，通过使用骨髓移植，复发率较高，但与治疗相关的死亡率较低，与治疗相关的死亡率为12-20%。认识到使用自体外周血移植较低的治疗相关死亡率，在对国际血液和移植研究中心登记数据的分析中，我们比较了首次完全缓解(中位年龄36-44岁，范围19-60岁)接受清髓HLA相合同胞供者移植(骨髓，n=475或外周血，n=428)与自体外周血(n=230)的急性髓系白血病患者的治疗相关死亡率、复发、无白血病存活率和总存活率。异基因骨髓、异基因外周血和自体外周血干细胞移植受者的5年累积死亡率分别为19%(95%可信区间，16-23%)、20%(17-24%)和8%(5-12%)。5年累积复发率分别为20%(17-24%)、26%(21-30%)和45%(38-52%)。5年无白血病生存率和总生存率相似：异基因骨髓61%(56-65%)和(59-68%)；异基因外周血54%(49-59%)和59%(54-%)；自体外周血47%(40-54%)和54%(47-60%)；多因素分析显示，自体外周血移植治疗相关死亡率低于异基因骨髓/外周血移植[相对危险度0.37(0.20~0.69)；P=0.001]，但治疗失败(死亡或复发)的发生率显著高于异基因骨髓/外周血移植[相对危险度1.32(1.06~1.64)；P=0.011]。然而，接受自体外周血(n=230)[相对危险度1.23(0.98~1.55)；P=0.071]或异基因骨髓/外周血(n=903)的患者的5年总生存期相似。对于首次完全缓解的急性髓系白血病患者，在没有匹配的同胞供者的情况下，自体外周血可提供可接受的缓解后替代疗法。
The optimal post-remission treatment for acute myeloid leukemia in first complete remission remains uncertain. Previous comparisons of autologous versus allogeneic hematopoietic cell transplantation noted higher relapse, but lower treatment-related mortality though using bone marrow grafts, with treatment-related mortality of 12-20%. Recognizing lower treatment-related mortality using autologous peripheral blood grafts, in an analysis of registry data from the Center for International Blood and Transplant Research, we compared treatment-related mortality, relapse, leukemia-free survival, and overall survival for patients with acute myeloid leukemia in first complete remission (median ages 36-44, range 19-60) receiving myeloablative HLA-matched sibling donor grafts (bone marrow, n=475 or peripheral blood, n=428) versus autologous peripheral blood (n=230). The 5-year cumulative incidence of treatment-related mortality was 19% (95% confidence interval, 16-23%), 20% (17-24%) and 8% (5-12%) for allogeneic bone marrow, allogeneic peripheral blood and autologous peripheral blood stem cell transplant recipients, respectively. The corresponding figures for 5-year cumulative incidence of relapse were 20% (17-24%), 26% (21-30%) and 45% (38-52%), respectively. At 5 years, leukemia-free survival and overall survival rates were similar: allogeneic bone marrow 61% (56-65%) and 64% (59-68%); allogeneic peripheral blood 54% (49-59%) and 59% (54-64%); autologous peripheral blood 47% (40-54%) and 54% (47-60%); P=0.13 and P=0.19, respectively. In multivariate analysis the incidence of treatment-related mortality was lower after autologous peripheral blood transplantation than after allogeneic bone marrow/peripheral blood transplants [relative risk 0.37 (0.20-0.69); P=0.001], but treatment failure (death or relapse) after autologous peripheral blood was significantly more likely [relative risk 1.32 (1.06-1.64); P=0.011]. The 5-year overall survival, however, was similar in patients who received autologous peripheral blood (n=230) [relative risk 1.23 (0.98-1.55); P=0.071] or allogeneic bone marrow/peripheral blood (n=903). In the absence of an HLA-matched sibling donor, autologous peripheral blood may provide acceptable alternative post-remission therapy for patients with acute myeloid leukemia in first complete remission.