Prevalence of extramedullary relapses is higher after allogeneic stem cell transplantation than after chemotherapy in adult patients with acute myeloid leukemia
Prevalence of extramedullary relapses is higher after allogeneic stem cell transplantation than after chemotherapy in adult patients with acute myeloid leukemia
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DOI：
10.1016/j.leukres.2013.08.017
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发表时间：
2013-11-01
影响因子：
2.7
通讯作者：
Nojima, Yoshihisa
中科院分区：
文献类型：
--
作者：
Shimizu, Hiroaki;Saitoh, Takayuki;Nojima, Yoshihisa
虽然研究表明急性髓系白血病（AML）患者异基因干细胞移植（allo-SCT）后髓外（EM）复发的患病率很高，但EM复发的患病率尚未与化疗后进行比较。本研究调查了498例接受强化化疗的成人AML患者（中位年龄57岁;范围15-82岁）的EM复发率。210例患者（36例在allo-SCT后; 245例在化疗后）共发生281次复发，33例（11.7%）复发伴有EM疾病。在这些复发中，异基因SCT后复发时观察到的EM疾病比化疗后更常见（分别为25%和9%; p = 0.008）。首次异基因造血干细胞移植后复发的33例患者中有8例患有EM疾病，只有广泛的慢性移植物抗宿主病（GVHD）被确定为EM复发的易感因素。此外，复发后1年总生存率与EM复发和BM复发患者相比无显著差异（分别为38%和16%; p = 0.279）。这些数据表明，接受allo-SCT的AML患者应密切随访EM复发的迹象，特别是那些患有广泛慢性GVHD的患者。(C)2013爱思唯尔有限公司保留所有权利。
Although studies have demonstrated a high prevalence of extramedullary (EM) relapse after allogeneic stem cell transplantation (allo-SCT) in patients with acute myeloid leukemia (AML), the prevalence of EM relapse has not been compared with that after chemotherapy. This study investigated the prevalence of EM relapse among 498 adult AML patients (median age, 57 years; range, 15-82 years) who underwent intensive chemotherapy. A total of 281 relapses occurred in 210 patients (36 after allo-SCT; 245 after chemotherapy), and 33 relapses (11.7%) were accompanied by EM disease. Among these relapses, EM disease was more frequently observed at relapse after allo-SCT than after chemotherapy (25% vs. 9%, respectively; p = 0.008). Eight of 33 relapses after the first allo-SCT had EM disease, and only presence of extensive chronic graft-versus-host disease (GVHD) was identified as a predisposing factor for EM relapse. Additionally, the 1-year overall survival rate after relapse was not significantly different when comparing those with EM relapse and those with BM relapse (38% vs. 16%, respectively; p = 0.279). These data suggest that AML patients undergoing allo-SCT should be closely followed for signs of EM relapse, especially those with extensive chronic GVHD. (C) 2013 Elsevier Ltd. All rights reserved.