Incidence, risk factors and outcome of extramedullary relapse after allogeneic hematopoietic stem cell transplantation in patients with adult acute lymphoblastic leukemia
Incidence, risk factors and outcome of extramedullary relapse after allogeneic hematopoietic stem cell transplantation in patients with adult acute lymphoblastic leukemia
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DOI：
10.1007/s00277-020-04199-9
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发表时间：
2020-09-05
影响因子：
3.5
通讯作者：
Huang, He
中科院分区：
文献类型：
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作者：
Yu, Jian;Ge, Xinyi;Huang, He
异基因造血干细胞移植（allo-HSCT）后髓外复发（EMR）仍然是一个临床挑战。目前有关急性淋巴细胞白血病 (ALL) 的 EMR 数据有限。本文对2008年3月至2017年12月期间在我中心接受allo-HSCT的268例成人ALL患者进行回顾性分析，以分析HSCT后的EMR。 90名患者（33.58%）出现复发； 51 人（19.03%）经历了骨髓复发（BMR），而 39 人（14.55%）经历了 EMR。 5 年累积 EMR 发生率 (CEMRI) 显示，匹配的兄弟姐妹供体 (MSD)-HSCT 比无关供体 (URD) 和半相合相关供体 (HRD)-HSCT 更容易发生 EMR（CEMRI：MSD、URD 和 HRD 分别为 24.02%、7.69% 和 14.69%）。值得注意的是，MSD-HSCT（URD 与 MSD 风险比 (HR) = 0.26，p = 0.015；HRD 与 MSD HR = 0.46，p = 0.032）、髓外病史 (EMD) (HR = 2.45，p = 0.041) 和 T 细胞 ALL (HR = 2.80，p = 0.012) 是独立危险因素用于多变量分析中的 EMR。所有患者的中位总生存期 (OS) 为 15.23 个月。然而，EMR 患者的 OS（19.50 个月）明显长于 BMR 患者（12.90 个月）（p = 0.003）。多变量分析显示，复发后死亡的主要危险因素是 HSCT 和复发之间的间隔较短（> 12 个月 vs
Extramedullary relapse (EMR) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) continues to remain a clinical challenge. The data on EMR in acute lymphoblastic leukemia (ALL) are currently limited. Herein, a retrospective analysis of 268 adult ALL patients who underwent allo-HSCT in our center between March 2008 and December 2017 was performed to analyze post-HSCT EMR. Ninety patients (33.58%) experienced relapse; 51(19.03%) experienced bone marrow relapse (BMR), whereas 39 (14.55%) experienced EMR. The 5-year cumulative EMR incidence (CEMRI) revealed that matched sibling donor (MSD)-HSCTs were more likely to develop EMR than unrelated donor (URD)- and haploidentical-related donor (HRD)-HSCTs (CEMRI: 24.02%, 7.69%, and 14.69% for MSD, URD, and HRD, respectively). Notably, MSD-HSCTs (URD vs MSD hazard ratio (HR) = 0.26,p = 0.015; HRD vs MSD HR = 0.46,p = 0.032), history of extramedullary disease (EMD) (HR = 2.45,p = 0.041), and T cell ALL (HR = 2.80,p = 0.012) were independent risk factors for EMR in the multivariate analysis. The median overall survival (OS) for all patients was 15.23 months. However, the OS of EMR patients was significantly longer (19.50 months) than that of BMR patients (12.90 months) (p = 0.003). Multivariate analyses revealed that the leading risk factors for post-relapse deaths were shorter intervals between HSCT and relapse (> 12 months vs