Reduced-intensity allogeneic hematopoietic stem cell transplantation combined with imatinib has comparable event-free survival and overall survival to long-term imatinib treatment in young patients with chronic myeloid leukemia
Reduced-intensity allogeneic hematopoietic stem cell transplantation combined with imatinib has comparable event-free survival and overall survival to long-term imatinib treatment in young patients with chronic myeloid leukemia
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降低强度同种异体造血干细胞移植联合伊马替尼治疗年轻慢性粒细胞白血病患者的无事件生存期和总生存期与长期伊马替尼治疗相当
DOI：
10.1007/s00277-017-3021-y
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发表时间：
2017-08-01
影响因子：
3.5
通讯作者：
Huang, He
中科院分区：
文献类型：
--
作者：
Zhao, Yanmin;Wang, Jiasheng;Huang, He
伊马替尼时代降低强度造血干细胞移植（RIST）治疗第一慢性期（CP）慢性粒细胞白血病（CML）的相对优点尚未得到评估。该研究旨在比较 RIST 加伊马替尼 (RIST + IM) 联合治疗与单独伊马替尼 (IM) 治疗早期 CP (ECP) 和晚期 CP (LCP) 年轻患者的结果。在这些患者中，130 名患者被非随机分配接受单独 IM 治疗 (n = 88) 或 RIST + IM 治疗 (n = 42)。 RIST + IM 组和 IM 组的 10 年总生存期 (OS) 和无事件生存期 (EFS) 相当。 LCP、高 Sokal 评分和 3 个月时没有完全细胞遗传学反应是生存的不良预后因素，但多变量分析后，只有从诊断到 IM 的时间是独立的预测因子。对于 ECP，IM 与 RIST + IM 相似，10 年 EFS 率分别为 77.2 比 81.6% (p= 0.876)，OS 率分别为 93.8 比 87.9% (p= 0.102)。对于 LCP，两种治疗的生存率相似，但伊马替尼组中有更多患者经历了事件（10 年 EFS 40.8 vs. 66.7%，p= 0.047）。 EBMT 风险评分较高的患者的生存率低于评分较低的患者（69.2% vs. 92.9%，p=0.04）。我们得出的结论是，RIST + IM 在 OS 和 EFS 方面与 IM 相当。然而，从 10 年的角度来看，RIST + IM 比单独的 IM 更便宜。因此，RIST + IM 可以被认为是一种替代治疗选择，特别是当患者 EBMT 风险评分较低且需要明确治愈 CML 时。
The relative merits of reduced intensity hematopoietic stem cell transplantation (RIST) for chronic myeloid leukemia (CML) in the first chronic phase (CP) in imatinib era have not been evaluated. The study was designed to compare the outcomes of combination therapy of RIST plus imatinib (RIST + IM) vs. imatinib (IM) alone for young patients with early CP (ECP) and late CP (LCP). Of the patients, 130 were non-randomly assigned to treatment with IM alone (n= 88) or RIST + IM (n= 42). The 10-year overall survival (OS) and event-free survival (EFS) were comparable between RIST + IM and IM groups. LCP, high Sokal score, and no complete cytogenetic response at 3 months were adverse prognostic factors for survival, but only the time from diagnosis to IM was an independent predictor after multivariate analysis. For ECP, IM was similar to RIST + IM, with 10-year EFS rates of 77.2 vs. 81.6% (p= 0.876) and OS rates of 93.8 vs. 87.9% (p= 0.102), respectively. For LCP, both treatments resulted in similar survival, but more patients in the imatinib group experienced events (10-year EFS 40.8 vs. 66.7%,p= 0.047). The patients with higher EBMT risk scores had an inferior survival than those with lower scores (69.2 vs. 92.9%,p= 0.04). We concluded that RIST + IM was comparable to IM in terms of OS and EFS. However, RIST + IM was more affordable than IM alone in a 10-year scale. Thus, RIST + IM could be considered as an alternative treatment option, especially when the patients have low EBMT risk scores and demand a definite cure for CML.