Relapse and Late Mortality in 5-Year Survivors of Myeloablative Allogeneic Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia in First Chronic Phase
Relapse and Late Mortality in 5-Year Survivors of Myeloablative Allogeneic Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia in First Chronic Phase
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DOI：
10.1200/jco.2009.26.7757
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发表时间：
2010-04-10
影响因子：
45.3
通讯作者：
Rizzo, J. Douglas
中科院分区：
文献类型：
--
作者：
Goldman, John M.;Majhail, Navneet S.;Rizzo, J. Douglas
目的异基因c造血细胞移植（HCT）是治疗慢性髓性白血病（CML）的有效方法，但其远期疗效尚不清楚。我们研究了接受同种异体HCT的慢性粒细胞白血病第一慢性期患者的长期预后。患者和方法我们的研究纳入了2444例患者，这些患者在1978年至1998年期间接受了第一慢性期CML的清髓性HCT治疗，并在连续完全缓解中存活了至少5年（中位随访11年，范围5至25年）。供体来源为1692例患者的人类白细胞抗原匹配的兄弟姐妹，639例患者的非亲属供体，113例患者的其他亲属供体。结果兄弟姐妹HCT患者15年总生存率为88% (95% Cl, 86% ~ 90%)，非亲属供体HCT患者15年总生存率为87% （95% Cl, 83% ~ 90%）。相应的累积复发率分别为8% （95% Cl, 7% ~ 10%）和2% （95% Cl, 1% ~ 4%）。最近一次复发是在hct后18年。在多变量分析中，慢性移植物抗宿主病的病史增加了晚期总死亡率和非复发死亡率的风险，但降低了复发风险。与年龄、种族和性别调整后的正常人群相比，HCT受者的死亡率在HCT后14年内显著升高；此后，死亡率与一般人群相似（15岁时的相对死亡率为2.3;95% Cl， 0至4.9）。结论同种异体HCT治疗CML第一慢性期患者，缓解期≥5年的患者后续长期生存良好，其死亡率最终接近一般人群。
Purpose Allogene c hematopoietic cell transplantation (HCT) is curative therapy for chronic myeloid leukemia (CML), but its long-term outcomes are not well described. We studied the long-term outcomes of CML patients in first chronic phase who receive an allogeneic HCT.Patients and Methods Our study included 2,444 patients who received myeloablative HCT for CML in first chronic phase between 1978 and 1998 and survived in continuous complete remission for at least 5 years (median follow-up, 11 years; range, 5 to 25 years). Donor sources were human leukocyte antigen matched siblings in 1,692 patents, unrelated donors in 639 patients, and other related donors in 113 patients.Results Overall survival rates at 15 years were 88% (95% Cl, 86% to 90%) for sibling HCT and 87% (95% Cl, 83% to 90%) for unrelated donor HCT. Corresponding cumulative incidences of relapse were 8% (95% Cl, 7% to 10%) and 2% (95% Cl, 1% to 4%), respectively. The latest relapse was reported 18 years post-HCT. In multivariable analyses, history of chronic graft-versus-host disease increased risks of late overall mortality and nonrelapse mortality but reduced risks of relapse. In comparison with age-, race-, and sex-adjusted normal populations, the mortality of HCT recipients was significantly higher until 14 years post-HCT; thereafter, mortality rates were similar to those of the general population (relative mortality ratio at 15 years, 2.3; 95% Cl, 0 to 4.9).Conclusion Recipients of allogeneic HCT for CML in first chronic phase who remain in remission for at least 5 years have favorable subsequent long-term survival, and their mortality rates eventually approach those of the general population.