Reduced intensity conditioning allows for up-front allogeneic hematopoietic stem cell transplantation after cytoreductive induction therapy in newly-diagnosed high-risk acute myeloid leukemia
Reduced intensity conditioning allows for up-front allogeneic hematopoietic stem cell transplantation after cytoreductive induction therapy in newly-diagnosed high-risk acute myeloid leukemia
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DOI：
10.1038/sj.leu.2404143
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发表时间：
2006-04-01
期刊：
影响因子：
11.4
通讯作者：
Bornhäuser, M
中科院分区：
文献类型：
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作者：
Platzbecker, U;Thiede, C;Bornhäuser, M
有实质性的需要，以改善高风险急性髓性白血病（AML）患者的结果。本文报告的临床试验研究了一种新的前期异基因造血干细胞移植（HSCT）方法，在26例新诊断的高风险AML患者中进行，诊断后中位数为40天（范围22-74），这些患者的特征是低风险细胞遗传学（n = 19）或诱导化疗（IC，n = 7）的原始细胞清除不足。中位年龄为49岁（范围17-68岁）。在第1个（n = 11）或第2个（n = 15）周期后IC诱导的再生障碍性贫血期间，患者接受了来自相关（n = 11）或无关（n = 15）供体的异基因外周血干细胞（PBSC），随后接受了基于氟达拉滨的降低强度方案。17例患者在HSCT前未缓解，中位骨髓原始细胞计数为34%（范围6-70）。所有患者均实现了快速植入，并进入完全骨髓和淋巴嵌合体的缓解期。14例（56%）患者发生了II级至IV级急性GvHD，8例（35%）患者记录了广泛的慢性GvHD。无病生存率为61%，仅3例患者分别在移植后5、6和7个月复发。作为主要诱导治疗的一部分，前期同种异体HSCT似乎是高危AML患者的有效策略，值得进一步研究。
There is substantial need to improve the outcome of patients with high-risk acute myeloid leukemia (AML). The clinical trial reported here investigated a new approach of up-front allogeneic hematopoietic stem cell transplantation (HSCT), provided a median of 40 days (range 22-74) after diagnosis, in twenty-six consecutive patients with newly-diagnosed high-risk AML characterized by poor-risk cytogenetics (n = 19) or inadequate blast clearance by induction chemotherapy (IC, n = 7). The median age was 49 years (range 17-68). During IC-induced aplasia after the 1st (n = 11) or 2nd (n = 15) cycle, patients received allogeneic peripheral blood stem cells (PBSC) from related (n = 11) or unrelated (n = 15) donors following a fludarabine-based reduced-intensity regimen. Seventeen patients were not in remission before HSCT with a median marrow blast count of 34% (range 6-70). All patients achieved rapid engraftment and went into remission with complete myeloid and lymphatic chimerism. Grades II to IV acute GvHD occurred in 14 (56%) and extensive chronic GvHD was documented in 8 (35%) patients. The probability of disease-free survival was 61% with only three patients relapsing 5, 6 and 7 months after transplantation, respectively. Up-front allogeneic HSCT as part of primary induction therapy seems to be an effective strategy in high-risk AML patients and warrants further investigation.