The superiority of haploidentical related stem cell transplantation over chemotherapy alone as postremission treatment for patients with intermediate- or high-risk acute myeloid leukemia in first complete remission
The superiority of haploidentical related stem cell transplantation over chemotherapy alone as postremission treatment for patients with intermediate- or high-risk acute myeloid leukemia in first complete remission
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对于首次完全缓解的中危或高危急性髓系白血病患者，半相合相关干细胞移植作为缓解后治疗优于单纯化疗
DOI：
10.1182/blood-2011-11-389809
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发表时间：
2012-06-07
期刊：
影响因子：
20.3
通讯作者：
Wang, Yu
中科院分区：
文献类型：
--
作者：
Huang, Xiao-Jun;Zhu, Hong-Hu;Wang, Yu
我们报告了一项前瞻性、患者自我选择研究的结果，评估了对于首次完全缓解（CR 1）的中高危急性髓性白血病（AML）患者，半相合相关供体干细胞移植（HRD-HSCT）作为缓解后治疗是否优于单纯化疗（上级）。在419例初治AML患者中，132例中高危细胞遗传学患者达到CR 1，缓解后接受单纯化疗（n = 74）或HSCT（n = 58）治疗。4年时复发的累积发生率为37.5% +/-4.5%。4年总生存率（OS）和无病生存率（DFS）分别为64.5% +/- 5.1%和55.6% +/-5.0%。HRD-HSCT组的累积复发率显著低于单纯化疗组（分别为12.0% +/- 4.6% vs 57.8% +/-6.2%; P <0.0001）。HRD-HSCT的上级生存率优于单纯化疗（4年DFS分别为73.1% +/- 7.1% vs 44.2% +/-6.2%; P <0.0001; 4年OS分别为77.5% +/- 7.1% vs 54.7% +/-6.3%; P = 0.001）。多变量分析显示缓解后治疗（HRD-HSCT与化疗）和诊断时高WBC计数是影响复发、DFS和OS的独立危险因素。我们的研究结果表明，HRD-HSCT作为AML缓解后治疗上级单纯化疗。（血。2012;119（23）：5584-5590）
We report the results of a prospective, patient self-selected study evaluating whether haploidentical related donor stem cell transplantation (HRD-HSCT) is superior to chemotherapy alone as postremission treatment for patients with intermediate-or high-risk acute myeloid leukemia (AML) in first complete remission (CR1). Among totally 419 newly diagnosed AML patients, 132 patients with intermediate-and high-risk cytogenetics achieved CR1 and received chemotherapy alone (n = 74) or HSCT (n = 58) as postremission treatment. The cumulative incidence of relapse at 4 years was 37.5% +/- 4.5%. Overall survival (OS) and disease-free survival (DFS) at 4 years were 64.5% +/- 5.1% and 55.6% +/- 5.0%, respectively. The cumulative incident of relapse for the HRD-HSCT group was significantly lower than that for the chemotherapy-alone group (12.0% +/- 4.6% vs 57.8% +/- 6.2%, respectively; P < .0001). HRD-HSCT resulted in superior survival compared with chemotherapy alone (4-year DFS, 73.1% +/- 7.1% vs 44.2% +/- 6.2%, respectively; P < .0001; 4-year OS, 77.5% +/- 7.1% vs 54.7% +/- 6.3%, respectively; P = .001). Multivariate analysis revealed postremission treatment (HRD-HSCT vs chemotherapy) and high WBC counts at diagnosis as independent risk factors affecting relapse, DFS, and OS. Our results suggest that HRD-HSCT is superior to chemotherapy alone as postremission treatment for AML. (Blood. 2012;119(23):5584-5590)