Hematopoietic Cell Transplantation in Young Adult Acute Lymphoblastic Leukemia: A United States Population-Level Analysis.
Hematopoietic Cell Transplantation in Young Adult Acute Lymphoblastic Leukemia: A United States Population-Level Analysis.
复制标题
年轻成人急性淋巴细胞白血病的造血细胞移植：美国人口水平分析。
DOI：
10.1089/jayao.2018.0140
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发表时间：
2019
影响因子：
2
通讯作者：
Keegan,TheresaHM
中科院分区：
文献类型：
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作者：
Muffly,Lori;Li,Qian;Alvarez,Elysia;Kahn,Justine;Winestone,Lena;Cress,Rosemary;Penn,DollyC;Keegan,TheresaHM
在这项基于人群的青少年和年轻成人（AYA）急性淋巴细胞白血病（ALL）的评价中，我们描述了首次完全缓解（CR 1）时造血细胞移植（HCT）的护理模式（POC）和结局。数据摘自2013年美国监测、流行病学和最终结果POC研究;纳入新诊断的AYA ALL。多变量逻辑回归评估了与CR 1中HCT的相关性;考克斯比例风险回归评估了生存相关性。在纳入的399例ALL AYA中，102例（28.5%）在CR 1时接受了HCT。高危细胞遗传学（比值比[OR] = 4.86，95%置信区间[CI] = 3.02-7.83）和高环磷酰胺、长春新碱、阿霉素和地塞米松（CVAD）诱导（OR = 1.84，95% CI = 1.07-3.16）与CR 1中的HCT相关。整个队列的2年累积复发率、无复发生存率（RFS）和总生存率（OS）分别为28.3%（95%CI = 23.4-33.4）、69.3%（95%CI = 63.6-74.3%）和84.1%（95%CI = 79.7-87.5）。接受CR 1 HCT的患者的2年RFS显著高于化疗患者（83.6%，95% CI = 72.6-90.5% vs. 64.3%，95% CI = 57.5-70.3），但2年OS无差异（88.9%，95% CI = 80.8-93.7 vs. 82.5%，95% CI = 77.2-86.7）。非教学医院的治疗与OS较差独立相关（风险比= 2.15，95%CI = 1.23-3.76）。虽然ALL的情况正在发生变化，但这些数据提供了美国AYA ALL使用HCT和结局的快照。
In this population-based evaluation of adolescents and young adults (AYA) acute lymphoblastic leukemia (ALL), we describe patterns of care (POC) and outcomes regarding hematopoietic cell transplantation (HCT) in first complete remission (CR1). Data were abstracted from the 2013 United States Surveillance, Epidemiology, and End Results POC study; newly diagnosed AYA ALL were included. Multivariable logistic regression evaluated associations with HCT in CR1; Cox proportional hazards regression evaluated survival associations. Of 399 AYAs with ALL included, 102 (28.5%) underwent HCT in CR1. High-risk cytogenetics (odds ratio [OR] = 4.86, 95% confidence interval [CI] = 3.02–7.83) and hyper-cyclophosphamide, vincristine, adriamycin, and dexamethasone (CVAD) induction (OR = 1.84, 95% CI = 1.07–3.16) were associated with HCT in CR1. Two-year cumulative incidence of relapse, relapse-free survival (RFS), and overall survival (OS) of the entire cohort were 28.3% (95% CI = 23.4–33.4), 69.3% (95% CI = 63.6–74.3%), and 84.1% (95% CI = 79.7–87.5), respectively. Two-year RFS was significantly higher in patients receiving CR1 HCT relative to chemotherapy (83.6%, 95% CI = 72.6–90.5% vs. 64.3%, 95% CI = 57.5–70.3), but no difference was seen in 2-year OS (88.9%, 95% CI = 80.8–93.7 vs. 82.5%, 95% CI = 77.2–86.7). Treatment at a nonteaching hospital was independently associated with inferior OS (hazard ratio = 2.15, 95% CI = 1.23–3.76). Although the ALL landscape is changing, these data provide a snapshot of the use and outcomes of HCT for AYA ALL across the United States.