Impact of pre-transplant disease burden on the outcome of allogeneic hematopoietic stem cell transplant in refractory and relapsed acute myeloid leukemia: a single-center study
Impact of pre-transplant disease burden on the outcome of allogeneic hematopoietic stem cell transplant in refractory and relapsed acute myeloid leukemia: a single-center study
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移植前疾病负担对难治性和复发性急性髓系白血病异基因造血干细胞移植结果的影响：一项单中心研究
DOI：
10.3109/10428194.2014.961016
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发表时间：
2015-05-01
影响因子：
2.6
通讯作者：
Wu, De-Pei
中科院分区：
文献类型：
--
作者：
Tian, Hong;Chen, Guang-Hua;Wu, De-Pei
对接受同种异体造血干细胞移植（HSCT）的难治性或复发性急性髓性白血病（AML）患者进行回顾性评估，以评估疾病负担对预后的影响并确定预测变量。在所有患者中，53例在移植前实现了完全形态缓解（CR-AML），而48例未能实现（NR-AML）。在CR-AML组中，32名患者表现出最小残留疾病（MRDpos）。所有患者的5年总生存率（5-OS）和无病生存率分别为37%和29%。CR-AML和NR-AML患者的5-OS差异显著（46% vs. 18%）。然而，移植前MRD状态不影响5-OS （MRDneg为51%，MRDpos为41%）。通过多变量分析，我们确定了患者的身体状况和风险分层作为附加的预后因素。我们的研究结果表明NR状态影响HSCT的结果，而移植前MRD不影响。HSCT需要相应优化，以治疗高风险AML。
Abstract Patients with refractory or relapsed acute myeloid leukemia (AML) receiving allogeneic hematopoietic stem cell transplant (HSCT) were retrospectively assessed to evaluate the effect of disease burden on outcomes and to identify predictive variables. Of all patients, 53 achieved a complete morphological remission (CR-AML) before transplant, while 48 failed to do so (NR-AML). In the CR-AML group, 32 patients displayed minimal residual disease (MRDpos). Estimated 5-year overall survival (5-OS) and disease-free survival of all patients was 37% and 29%, respectively. The 5-OS was significantly different between patients with CR-AML and NR-AML (46% vs. 18%). However, pre-transplant MRD status did not affect 5-OS (51% in MRDneg vs. 41% in MRDpos). Using multivariate analysis, we identified patient's physical condition and risk stratification as additional prognostic factors. Our findings suggest that NR status influences the outcomes of HSCT while pre-transplant MRD does not. HSCT needs to be optimized accordingly to treat high risk AML.