Comparable Survival for Pediatric Acute Myeloid Leukemia With Poor-Risk Cytogenetics Following Chemotherapy, Matched Related Donor, or Unrelated Donor Transplantation
Comparable Survival for Pediatric Acute Myeloid Leukemia With Poor-Risk Cytogenetics Following Chemotherapy, Matched Related Donor, or Unrelated Donor Transplantation
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DOI：
10.1002/pbc.24739
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发表时间：
2014-02-01
影响因子：
3.2
通讯作者：
Woods, William G.
中科院分区：
文献类型：
--
作者：
Kelly, Michael J.;Horan, John T.;Woods, William G.
背景我们试图更好地确定造血细胞移植（HCT）在高危儿童急性髓细胞白血病（AML）首次缓解（CR 1）中的作用。程序比较年龄小于21岁的细胞遗传学定义的低风险AML患者在CR 1中接受化疗、匹配相关（MRD）或无关供体（URD）移植的结果。低风险细胞遗传学定义为单体7/del 7 q、单体5/del 5 q、3q、t（6;9）（p23;q34）异常或复杂核型。包括1989年至2006年在儿童肿瘤组试验中接受治疗或向国际血液和骨髓移植研究中心报告的患者。结果233例患者中，123例接受化疗，55例接受MRD HCT，55例接受URD HCT。从巩固化疗或移植预处理开始的5年总生存率相似：化疗（43%9%），MRD（46%+/- 14%）或URD（50%+/- 14%），P=0.99。相似地，多变量分析显示生存率无显著差异[（对照组=化疗）：MRD HR 1.08，P=0.76; URD HR 1.13，P=0.67]，尽管URD HCT的复发风险较低（HR=0.43，P=0.01）。结论我们的研究结果并不支持优先使用HCT化疗单独的细胞遗传学定义的低风险AML的儿童CR 1。儿科血液癌症2014;61：269-275。(c)2013 Wiley Periodicals，Inc.
BackgroundWe sought to better define the role of hematopoietic cell transplantation (HCT) in first remission (CR1) for high-risk pediatric acute myeloid leukemia (AML).ProceduresOutcomes were compared among patients aged less than 21 years with cytogenetically defined poor-risk AML treated with chemotherapy, matched related (MRD), or unrelated donor (URD) transplantation in CR1. Poor-risk cytogenetics was defined as monosomy 7/del7q, monosomy 5/del 5q, abnormalities of 3q, t(6;9)(p23;q34), or complex karyotype. Included are patients treated on Children's Oncology Group trials or reported to the Center for International Blood and Marrow Transplant Research from 1989 to 2006.ResultsOf the 233 patients, 123 received chemotherapy, 55 received MRD HCT, and 55 received URD HCT. The 5-year overall survival from the time of consolidation chemotherapy or transplant conditioning was similar: chemotherapy (43%9%), MRD (46%+/- 14%), or URD (50%+/- 14%), P=0.99. Similarly, multivariate analysis demonstrated no significant differences in survival [(reference group=chemotherapy); MRD HR 1.08, P=0.76; URD HR 1.13, P=0.67] despite lower relapse risk with URD HCT (HR=0.43, P=0.01).ConclusionsOur findings do not provide support for the preferential use of HCT over chemotherapy alone for children with cytogenetically defined poor-risk AML in CR1. Pediatr Blood Cancer 2014;61:269-275. (c) 2013 Wiley Periodicals, Inc.