Myeloablative vs nonmyeloablative allogeneic transplantation for patients with myelodysplastic syndrome or acute myelogenous leukemia with multilineage dysplasia: a retrospective analysis
Myeloablative vs nonmyeloablative allogeneic transplantation for patients with myelodysplastic syndrome or acute myelogenous leukemia with multilineage dysplasia: a retrospective analysis
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DOI：
10.1038/sj.leu.2404010
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发表时间：
2006-01-01
期刊：
影响因子：
11.4
通讯作者：
Deeg, HJ
中科院分区：
文献类型：
--
作者：
Scott, BL;Sandmaier, BM;Deeg, HJ
分析150例骨髓增生异常综合征(MDS)或由MDS转化而来的急性髓系白血病(TAML)患者接受非清髓或清髓方案治疗后的移植结果。38例患者接受2GY全身照射(n=2)或氟达拉滨(n=36)90 mg/m(2例)非清髓方案治疗。112例患者接受白消安16 mg/kg(靶向800-900 ng/ml)和环磷酰胺120 mg/kg的清髓方案治疗。非清髓性患者年龄较大(中位年龄62比52岁，P=0.001)，进展为急性髓系白血病(53比31%，P=0.06)，国际预后评分系统有更高的疾病风险(53比30%，P=0.004)，有更高的移植特异性共病指数(68比42%，P=0.004)，更频繁地对诱导化疗有持久的完全反应(58比14%)。三年总生存率(27%/48%，P=0.56)、无进展生存率(28%/44%，P=0.60)和无复发死亡率(41%/34%，P=0.94)在非清髓和清髓条件下无显著差异。化疗诱导缓解患者的总体生存率(HR=0.9，P=0.84)和无进展生存率(HR=1，P=0.93)相似，与条件反射强度无关。在移植时化疗诱导缓解的患者中，移植物对白血病的影响可能比调节强度更重要。需要进行随机前瞻性研究，以进一步解决髓系肿瘤移植条件强度的最佳选择。
Transplant outcome was analyzed in 150 patients with myelo-dysplastic syndrome (MDS) or acute myelogenous leukemia transformed from MDS (tAML) conditioned with nonmyeloablative or myeloablative regimens. A total of 38 patients received nonmyeloablative regimens of 2Gy total body irradiation alone (n = 2) or with fludarabine (n = 36), 90mg/m(2). A total of 112 patients received a myeloablative regimen of busulfan, 16 mg/kg ( targeted to 800-900 ng/ml), and cyclophosphamide 120 mg/kg. Nonmyeloablative patients were older ( median age 62 vs 52 years, P < 0.001), more frequently had progressed to tAML ( 53 vs 31%, P = 0.06), had higher risk disease by the International Prognostic Scoring System ( 53 vs 30%, P = 0.004), had higher transplant specific comorbidity indices ( 68 vs 42%, P = 0.01) and more frequently had durable complete responses to induction chemotherapy ( 58 vs 14%). Three-year overall survival (27%/48% ( P = 0.56)), progression-free survival (28%/44%, ( P = 0.60)), and nonrelapse mortality (41%/34%, ( P = 0.94)) did not differ significantly between nonmyeloblative/ myeloablative conditioning. Overall (HR = 0.9, P = 0.84) and progression-free survivals (HR = 1, P = 0.93) were similar for patients with chemotherapy-induced remissions irrespective of conditioning intensity. Graft vs leukemia effects may be more important than conditioning intensity in preventing progression in patients in chemotherapy-induced remissions at the time of transplantation. Randomized prospective studies are needed to further address the optimal choice of transplant conditioning intensity in myeloid neoplasms.