Prognosis and risk factors for central nervous system relapse after allogeneic hematopoietic stem cell transplantation in acute myeloid leukemia
Prognosis and risk factors for central nervous system relapse after allogeneic hematopoietic stem cell transplantation in acute myeloid leukemia
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急性髓系白血病异基因造血干细胞移植后中枢神经系统复发的预后及危险因素
DOI：
10.1007/s00277-020-04380-0
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发表时间：
2021-01-02
影响因子：
3.5
通讯作者：
Zhang, Xiao-Hui
中科院分区：
文献类型：
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作者：
Chen, Qi;Zhu, Xiao-Lu;Zhang, Xiao-Hui
我们进行了一项巢式病例对照研究，以调查异基因造血干细胞移植（allo-HSCT）治疗急性髓系白血病（AML）后中枢神经系统（CNS）复发的发生率、治疗和预后，并比较了半相合供者（HID）HSCT与同胞供者（ISD）HSCT后CNS复发患者的结局。2009年1月至2019年1月期间，共有37例患者（HID-HSCT，24例; ISD-HSCT，13例）在移植后发生CNS复发，发生率为1.81%。从移植到CNS复发的中位时间为239天。HSCT前CNS受累（HR 6.940，95%CI 3.146- 15.306，p <0.001）是AML患者allo-HSCT后CNS复发的独立危险因素。CNS复发患者的3年总生存率（OS）为60.3 ± 8.8%，显著低于对照组（81.5 ± 4.5%，p = 0.003）。接受HID-HSCT的患者CNS复发率为1.64%，接受ISD-HSCT的患者为2.55%（p= 0.193）。在CNS复发患者中，HID-HSCT和ISD-HSCT亚组之间的OS无显著差异。总之，CNS复发是AML allo-HSCT后罕见但严重的并发症，HID-HSCT和ISD-HSCT后CNS复发患者的发生率和结局相当。
We performed a nested case-control study to investigate the incidence, treatment, and prognosis of central nervous system (CNS) relapse after allogenic hematopoietic stem cell transplantation (allo-HSCT) for acute myeloid leukemia (AML) and compared the outcomes of patients with CNS relapse following haploidentical donor (HID) HSCT versus identical sibling donor (ISD) HSCT. A total of 37 patients (HID-HSCT, 24; ISD-HSCT, 13) developed CNS relapse after transplantation between January 2009 and January 2019, with an incidence of 1.81%. The median time from transplantation to CNS relapse was 239 days. Pre-HSCT CNS involvement (HR 6.940, 95% CI 3.146–15.306,p< .001) was an independent risk factor for CNS relapse after allo-HSCT for AML. The 3-year overall survival (OS) for patients with CNS relapse was 60.3 ± 8.8%, which was significantly lower than that in the controls (81.5 ± 4.5%,p= .003). The incidence of CNS relapse was 1.64% for patients who received HID-HSCT and 2.55% for those who received ISD-HSCT (p= .193). There was no significant difference in OS between the HID-HSCT and ISD-HSCT subgroups among the patients with CNS relapse. In conclusion, CNS relapse is a rare but serious complication after allo-HSCT for AML, and the incidence and outcomes of patients with CNS relapse are comparable following HID-HSCT and ISD-HSCT.