Reducing the Risk for Transplantation-Related Mortality After Allogeneic Hematopoietic Cell Transplantation: How Much Progress Has Been Made?
Reducing the Risk for Transplantation-Related Mortality After Allogeneic Hematopoietic Cell Transplantation: How Much Progress Has Been Made?
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DOI：
10.1200/jco.2010.32.5001
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发表时间：
2011-03-01
影响因子：
45.3
通讯作者：
Pasquini, Marcelo C.
中科院分区：
文献类型：
--
作者：
Horan, John T.;Logan, Brent R.;Pasquini, Marcelo C.
目的移植相关死亡率(TRM)是异基因造血细胞移植(HCT)成功的主要障碍。我们评估了5,972例年龄在50岁以下的急性髓系白血病(AML)首次完全缓解(CR1)和第二次完全缓解(CR2)患者在1985年至2004年期间的TRM发生率和总存活率的变化。结果在HLA相合的同胞供者移植受者中，CR1和CR2患者在2000~2004年发生TRM的相对危险度(RRS)分别为0.5和0.3(P<；.001)。CR1组和CR2组后期全死因的相对危险度分别为0.73(P<0.01)和0.60(P=0.005)。在无血缘关系的供者移植受者中，与1990年至1994年相比，CR1和CR2组在2000年至2004年的TRM的RRS分别为0.73(P=.095)和0.58(P<；.001)。CR2组的死亡率下降(RR，0.74；P=0.03)，但CR1组的死亡率没有下降。结论我们的结果表明，自20世纪80年代和90年代以来，移植治疗的创新降低了接受异基因HCT治疗AML的患者发生TRM的风险，这种减少伴随着总体生存的改善。J Clin Oncol29：805-813(C)2011年美国临床肿瘤学会
Purpose Transplantation-related mortality (TRM) is a major barrier to the success of allogeneic hematopoietic cell transplantation (HCT).Patients and Methods We assessed changes in the incidence of TRM and overall survival from 1985 through 2004 in 5,972 patients younger than age 50 years who received myeloablative conditioning and HCT for acute myeloid leukemia (AML) in first complete remission (CR1) or second complete remission (CR2).Results Among HLA-matched sibling donor transplantation recipients, the relative risks (RRs) for TRM were 0.5 and 0.3 for 2000 to 2004 compared with those for 1985 to 1989 in patients in CR1 and CR2, respectively (P < .001). The RRs for all causes of mortality in the latter period were 0.73 (P < .001) and 0.60 (P = .005) for the CR1 and CR2 groups, respectively. Among unrelated donor transplantation recipients, the RRs for TRM were 0.73 (P = .095) and 0.58 (P < .001) for 2000 to 2004 compared with those in 1990 to 1994 in the CR1 and CR2 groups, respectively. Reductions in mortality were observed in the CR2 group (RR, 0.74; P = .03) but not in the CR1 group.Conclusion Our results suggest that innovations in transplantation care since the 1980s and 1990s have reduced the risk of TRM in patients undergoing allogeneic HCT for AML and that this reduction has been accompanied by improvements in overall survival. J Clin Oncol 29:805-813. (C) 2011 by American Society of Clinical Oncology