Comparison of Autologous Stem Cell Transplantation versus Haploidentical Donor Stem Cell Transplantation for Favorable- and Intermediate-Risk Acute Myeloid Leukemia Patients in First Complete Remission
Comparison of Autologous Stem Cell Transplantation versus Haploidentical Donor Stem Cell Transplantation for Favorable- and Intermediate-Risk Acute Myeloid Leukemia Patients in First Complete Remission
复制标题
自体干细胞移植与单倍体供体干细胞移植治疗首次完全缓解的有利和中危急性髓系白血病患者的比较
DOI：
10.1016/j.bbmt.2017.12.796
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发表时间：
2018-04-01
影响因子：
4.3
通讯作者：
Wu, Depei
中科院分区：
文献类型：
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作者：
Chen, Jia;Yang, Lingyi;Wu, Depei
干细胞移植（SCT）是中度风险急性髓细胞白血病（AML）患者和一些具有额外非遗传风险因素的可缓解风险AML患者的一种有吸引力的缓解后治疗选择。自体SCT（auto-SCT）和单倍相合供体SCT（haplo-SCT）是缺乏HLA匹配供体的情况下广泛使用的替代方案。然而，关于这两种移植类型之间的直接比较的数据有限。根据我们中心的移植数据库，我们进行了一项回顾性研究，涉及根据国家综合癌症网络指南首次完全缓解（CR 1）的有利和中等风险AML患者。排除髓外疾病患者或超过2个周期达到CR的患者。总共有195名患者被纳入研究，其中88名接受了auto-SCT，107名接受了haplo-SCT。在整个队列分析中，auto-SCT组的高复发发生率的影响被低非复发死亡率（NRM）补偿，这导致了相当的总生存期（OS）（79.0%+/- 4.6%对80.1%+/-5.0%，P= 0.769）和无复发生存率（RFS）（66.1%+/- 5.2%对77.4%+/-4.8%，P= 0.079）。然而，对于中度风险AML患者，两组之间的NRM相似，单倍体SCT表现出上级生存率。在SCT后复发的情况下，中危AML患者的3年OS明显低于高危AML患者（23.3%+/- 9.8% vs 60.8%+/-14.3%，P= 0.011）。在多变量分析中，流式细胞术测量的微小残留病（MRD）和移植前的基因突变状态是OS和RFS的独立预测因子。我们得出结论，自体SCT和单倍体SCT都是有利和中等风险AML患者缓解后治疗的可接受选择。Haplo-SCT在中等风险AML患者中获得了更好的结局，但SCT后复发仍导致不良结局。SOT前清除MRD可改善移植后的预后。(C)2017年美国血液和骨髓移植协会。
Stem cell transplantation (SCT) is an attractive postremission treatment option for patients with intermediate risk acute myeloid leukemia (AML) and for some favorable-risk AML patients with additional nongenetic risk factors. Autologous SCT (auto-SCT) and haploidentical donor SCT (haplo-SCT) are the widely used alternatives in cases of a lack of a HLA-matched donor. However, limited data have been published on the direct comparison between these 2 transplant types. Based on the transplant database in our center, we conducted a retrospective study involving patients with favorable- and intermediate-risk AML in first complete remission (CR1), according to the National Comprehensive Cancer Network guideline. Patients with extramedullary disease or those achieving CR by more than 2 cycles were excluded. In total, 195 patients were included in the study, 88 of whom underwent auto-SCT and 107 haplo-SCT. In the entire cohort analyses the impact of high relapse incidence in the auto-SCT group was compensated by low nonrelapse mortality (NRM), which resulted in a comparable overall survival (OS) (79.0%+/- 4.6% versus 80.1%+/- 5.0%, P=.769) and relapse-free survival (RFS) (66.1%+/- 5.2% versus 77.4%+/- 4.8%, P=.079) compared with those observed in the haplo-SCT group. However, for patients with intermediate-risk AML NRM was similar between the groups, and haplo-SCT exhibited superior survival. In case of post-SCT relapse, patients with intermediate-risk AML showed markedly inferior 3-year OS compared with that shown by patients with favorable-risk AML (23.3%+/- 9.8% versus 60.8%+/- 14.3%, P=.011). In the multivariate analyses, minimal residual disease (MRD) measured by flow cytometry and gene mutation status before transplantation were independent predictors for both OS and RFS. We concluded that both auto-SCT and haplo-SCT were acceptable options for postremission treatment of patients with favorable- and intermediate-risk AML. Haplo-SCT yielded a better outcome in patients with intermediate risk AML, but the relapse after SCT still led to a poor outcome. Clearance of MRD before SOT could improve the prognosis after transplantation. (C) 2017 American Society for Blood and Marrow Transplantation.