Extramedullary Relapse of Acute Leukemia after Allogeneic Hematopoietic Stem Cell Transplantation: Different Characteristics between Acute Myelogenous Leukemia and Acute Lymphoblastic Leukemia
Extramedullary Relapse of Acute Leukemia after Allogeneic Hematopoietic Stem Cell Transplantation: Different Characteristics between Acute Myelogenous Leukemia and Acute Lymphoblastic Leukemia
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异基因造血干细胞移植后急性白血病髓外复发：急性粒细胞白血病与急性淋巴细胞白血病的不同特点
DOI：
10.1016/j.bbmt.2014.03.030
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发表时间：
2014-07-01
影响因子：
4.3
通讯作者：
Tang, Xiaowen
中科院分区：
文献类型：
--
作者：
Ge, Ling;Ye, Fan;Tang, Xiaowen
同种异体造血干细胞移植（alloo - hsct）后急性白血病（AL）的髓外复发（EMR）是移植后死亡率的一个因素，但人们对其了解甚少，尤其是急性髓性白血病（AML）和急性淋巴细胞白血病（ALL）患者EMR的不同特征。为了调查AML和ALL的EMR发生率、危险因素和临床结果，我们对2001年1月至2012年3月在东吴大学第一附属医院接受同种异体造血干细胞移植的362例AL患者进行了回顾性分析。与AML患者相比，ALL患者的EMR发生率更高（12.9% vs 4.6%; P = 0.009）。EMR最常见的部位是中枢神经系统，尤其是ALL组。多因素分析发现，AML患者EMR的主要危险因素为HSCT时的疾病晚期、诊断时的高白细胞血症、HSCT前的髓外白血病史和基于全身照射的调节方案，ALL患者EMR的主要危险因素为诊断时的高白细胞血症、不良细胞遗传学和外周血干细胞输血。AL的EMR预后较差，治疗选择非常有限；然而，AML患者的3年总生存率（OS）明显低于ALL患者（0比18.5%;P = 0.000）。AML患者与ALL患者的异基因造血干细胞移植后EMR特征不同，可能提示AML与ALL患者异基因造血干细胞移植后EMR的发病机制不同；需要进一步调查。(C) 2014年美国血液和骨髓移植学会。
Extramedullary relapse (EMR) of acute leukemia (AL) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a contributor to post-transplantation mortality and remains poorly understood, especially the different characteristics of EMR in patients with acute myelogenous leukemia (AML) and those with acute lymphoblastic leukemia (ALL). To investigate the incidence, risk factors, and clinical outcomes of EMR for AML and ALL, we performed a retrospective analysis of 362 patients with AL who underwent allo-HSCT at the First affiliated Hospital of Soochow University between January 2001 and March 2012. Compared with patients with AML, those with ALL had a higher incidence of EMR (12.9% versus 4.6%; P = .009). The most common site of EMR was the central nervous system, especially in the ALL group. Multivariate analyses identified the leading risk factors for EMR in the patients with AML as advanced disease status at HSCT, hyperleukocytosis at diagnosis, history of extramedullary leukemia before HSCT, and a total body irradiation based conditioning regimen, and the top risk factors for EMR in the patients with ALL as hyperleukocytosis at diagnosis, adverse cytogenetics, and transfusion of peripheral blood stem cells. The prognosis for EMR of AL is poor, and treatment options are very limited; however, the estimated 3-year overall survival (OS) was significantly lower in patients with AML compared with those with ALL (0 versus 18.5%; P = .000). The characteristics of post-allo-HSCT EMR differed between the patients with AML and those with ALL possibly suggesting different pathogenetic mechanisms for EMR of AML and EMR of ALL after allo-HSCT; further investigation is needed. (C) 2014 American Society for Blood and Marrow Transplantation.