Early T-Cell Precursor Acute Lymphoblastic Leukemia and T/Myeloid Mixed Phenotype Acute Leukemia Possess Overlapping Characteristics and Both Benefit From CAG-Like Regimens and Allogeneic Hematopoietic Stem Cell Transplantation
Early T-Cell Precursor Acute Lymphoblastic Leukemia and T/Myeloid Mixed Phenotype Acute Leukemia Possess Overlapping Characteristics and Both Benefit From CAG-Like Regimens and Allogeneic Hematopoietic Stem Cell Transplantation
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早期 T 细胞前体急性淋巴细胞白血病和 T/髓细胞混合表型急性白血病具有重叠的特征，并且均受益于类 CAG 治疗方案和同种异体造血干细胞移植
DOI：
10.1016/j.jtct.2021.02.032
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发表时间：
2021-06-15
影响因子：
3.2
通讯作者：
Tang, Xiaowen
中科院分区：
文献类型：
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作者：
Liu, Sining;Cui, Qingya;Tang, Xiaowen
早期T细胞前体急性淋巴细胞白血病（ETP-ALL）和T淋巴细胞/髓系混合表型急性白血病（T/M-MPAL）是密切相关的实体，仍然是治疗的挑战。在这项研究中，我们描述了43例ETP-ALL和41例T/M-MPAL患者的临床特征，并比较了34例患者的阿糖胞苷、阿糖胞苷和粒细胞集落刺激因子（CAG）样方案与50例常规ALL方案的临床结局和安全性。在我们的系列研究中，ETP-ALL和T/M-MPAL显示出相似的生物学特征、免疫表型、基因组改变和结局。CAG样方案的完全缓解（CR）率和微小残留病（MRD）阴性CR率显著高于常规ALL方案（CAG样：分别为80.0%和59.7%; P = 0.039; ALL：分别为51.4%和31.3%; P = 0.048）。总体而言，90.0%的病例（18/20）使用联合地西他滨和CAG样方案达到CR。此外，CAG样方案的3级或4级感染率（18.8% vs. 38.2%; P = 0.059）和1级或2级肝毒性（37.5% vs. 60.0%; P = 0.043）低于常规ALL方案。异基因造血干细胞移植38例首次CR（CR 1）的allo-HSCT患者的总生存期（OS）和无白血病生存期（LFS）优于第二次CR（CR2）或未缓解的11例接受allo-HSCT的患者。（未达到中位OS vs. 7.6个月，P = .0004;未达到中位LFS vs. 11.6个月，P = .0008）。在移植前MRD阴性和MRD阳性患者之间，allo-HSCT后3年OS（95.7% vs. 52.5%; P = .0039）和LFS（95.8% vs. 43.5%; P = .0003）存在显著差异。CAG样组中无allo-HSCT患者的中位OS为32.1个月，而非CAG样组为12.1个月（P = 0.019）。这些发现表明ETPALL和T/M-MPAL具有重叠的特征，CAG样方案改善了其临床结局。(C)2021年美国移植和细胞治疗学会。爱思唯尔公司出版All rights reserved.
Early T-cell precursor acute lymphoblastic leukemia (ETP-ALL) and T-lymphoid/myeloid mixed phenotype acute leukemia (T/M-MPAL) are closely related entities and remain a therapeutic challenge. In this study, we characterized the clinical features of 43 ETP-ALL and 41 T/M-MPAL patients and compared clinical outcomes and safety between cytarabine, aclarubicin, and granulocyte colony-stimulating factor (CAG)-like regimens in 34 patients and conventional ALL regimens in 50 patients. In our series, ETP-ALL and T/M-MPAL showed similar biological characteristics, immunophenotypes, genomic alterations, and outcomes. The complete remission (CR) rate and minimal residual disease (MRD)-negative CR rate of CAG-like regimens were significantly higher compared with conventional ALL regimens (CAG-like: 80.0% and 59.7%, respectively; P = .039; ALL: 51.4% and 31.3%, respectively; P = .048). Overall, 90.0% of cases (18/20) achieved CR using combined decitabine and CAG-like regimens. Additionally, CAG-like regimens had lower rates of grade 3 or 4 infection (18.8% vs. 38.2%; P = .059) and grade 1 or 2 hepatotoxicity (37.5% vs. 60.0%; P = .043) than conventional ALL regimens. The 38 patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the first CR (CR1) had better overall survival (OS) and leukemia-free survival (LFS) than the 11 patients who underwent allo-HSCT in the second CR (CR2) or in no remission (median OS not reached vs. 7.6 months, P = .0004; median LFS not reached vs. 11.6 months, P = .0008). There was a significant difference in 3-year OS (95.7% vs. 52.5%; P = .0039) and LFS (95.8% vs. 43.5%; P = .0003) after allo-HSCT between pre-transplant MRD-negative and MRD-positive patients. The median OS for patients without allo-HSCT was 32.1 months in the CAG-like group compared with 12.1 months in the non-CAG-like group (P = .019). These findings suggest that ETPALL and T/M-MPAL possess overlapping characteristics and CAG-like regimens improve their clinical outcomes. (C) 2021 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.