Survival of patients with acute myeloid leukemia relapsing after allogeneic hematopoietic cell transplantation: a center for international blood and marrow transplant research study.
Survival of patients with acute myeloid leukemia relapsing after allogeneic hematopoietic cell transplantation: a center for international blood and marrow transplant research study.
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DOI：
10.1016/j.bbmt.2014.11.007
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发表时间：
2015-03
期刊：
影响因子：
--
通讯作者：
Zhang MJ
中科院分区：
文献类型：
--
作者：
Bejanyan N;Weisdorf DJ;Logan BR;Wang HL;Devine SM;de Lima M;Bunjes DW;Zhang MJ
同种异体造血细胞移植（alloHCT）后急性髓系白血病（AML）复发仍然是一个主要的治疗挑战。我们研究了1788例同种异体造血干细胞移植后复发的AML患者（1990-2010）在第一次或第二次完全缓解（CR）期间的结果，以确定与复发后生存期延长相关的因素。HCT后复发的中位时间为7个月（mo，范围1-177）。复发时，1231例（69%）患者接受了强化治疗，包括单独化疗（CT） （n=660），供体淋巴细胞输注（DLI）±CT (n=202; %)，或第二次同种异体hct±CT±DLI (n=369)，随后的CR率为29%。复发后中位随访时间为39个月（范围< 1-193）。复发后1年，所有患者的生存率为23%；然而，3年总生存率与从HCT到复发的时间相关（1-6个月复发4%，6 -2年复发12%，2-3年复发26%，≥3年复发38%）。在多变量分析中，较低的死亡率与从异位HCT到复发的时间较长（6个月至2年的RR为0.55,2-3年的RR为0.39，≥3年的RR为0.28;p<0.0001）和第一次HCT使用低强度调节（RR=0.77; 95% CI 0.66-0.88, p=0.0002）显著相关。相比之下，较差的生存率与以下因素相关：年龄50 - 40岁（RR=1.42, 95% CI 1.24-1.64, p<0.0001），复发时活动性GVHD (RR=1.25, 95% CI 1.13-1.39, p<0.0001)，不良细胞遗传学（RR=1.37, 95% CI 1.09-1.71, p=0.0062），不匹配的URD (RR=1.61, 95% CI 1.22-2.13, p=0.0008)，以及首次HCT使用脐带血（RR=1.23, 95% CI 1.06-1.42, p=0.0078）。同种异体hct后AML复发预示较差的生存期；然而，初次同种异体ct后复发≥6个月的患者生存率更高，可能受益于强化治疗，如第二次同种异体ct±DLI。
Acute myeloid leukemia (AML) relapse after allogeneic hematopoietic cell transplantation (alloHCT) remains a major therapeutic challenge. We studied outcomes of 1788 AML patients relapsing after alloHCT (1990–2010) during first or second complete remission (CR) to identify factors associated with longer post-relapse survival. Median time of post HCT relapse was 7 months (mo; range, 1–177). At relapse, 1231 patients (69%) received intensive therapy, including chemotherapy (CT) alone (n=660), donor lymphocyte infusion (DLI)±CT (n=202; %), or 2nd alloHCT±CT ±DLI (n=369), with subsequent CR rates of 29%. Median follow-up after relapse was 39 mo (range, <1–193). Survival for all patients was 23% at 1 year post-relapse; however, 3-yr overall survival correlated with time from HCT to relapse (4% for relapse during 1–6 mo period, 12% during 6 mo-2 yr, 26% during 2–3 yr, and 38% for ≥3 yr). In multivariable analysis, lower mortality was significantly associated with longer time from alloHCT to relapse (RR 0.55 for 6 mo-2 yr, RR 0.39 for 2–3 yr, and RR 0.28 for ≥3 yr; p<0.0001) and a 1st HCT using reduced-intensity conditioning (RR=0.77; 95% CI 0.66–0.88, p=0.0002). In contrast, inferior survival was associated with age >40 yr (RR=1.42, 95% CI 1.24–1.64; p<0.0001), active GVHD at relapse (RR=1.25, 95% CI 1.13–1.39; p<0.0001), adverse cytogenetics (RR=1.37, 95% CI 1.09–1.71; p=0.0062), mismatched URD (RR=1.61, 95% CI 1.22–2.13; p=0.0008), and use of cord blood for 1st HCT (RR=1.23, 95% CI 1.06–1.42; p=0.0078). AML relapse after alloHCT predicted poor survival; however, patients who relapsed ≥6 mo after their initial alloHCT had better survival and may benefit from intensive therapy such as 2nd alloHCT±DLI.
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DOI：
10.1016/j.bbmt.2008.12.497
发表时间：
2009-03
期刊：
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
影响因子：
--
作者：
Giralt S;Ballen K;Rizzo D;Bacigalupo A;Horowitz M;Pasquini M;Sandmaier B
通讯作者：
Sandmaier B
影响因子：
4.3
作者：
Bacigalupo, Andrea;Ballen, Karen;Rizzo, Doug;Giralt, Sergio;Lazarus, Hillard;Ho, Vincent;Apperley, Jane;Slavin, Shimon;Pasquini, Marcelo;Sandmaier, Brenda M.;Barrett, John;Blaise, Didier;Lowski, Robert;Horowitz, Mary
通讯作者：
Horowitz, Mary
影响因子：
20.3
作者：
Schmid, Christoph;Labopin, Myriam;Mohty, Mohamad
通讯作者：
Mohty, Mohamad
影响因子：
45.3
作者：
Schmid, Christoph;Labopin, Myriam;Rocha, Vanderson
通讯作者：
Rocha, Vanderson
影响因子：
4.3
作者：
Thanarajasingam, Gita;Kim, Haesook T.;Cutler, Corey;Ho, Vincent T.;Koreth, John;Alyea, Edwin P.;Antin, Joseph H.;Soiffer, Robert J.;Armand, Philippe
通讯作者：
Armand, Philippe