Pretransplantation therapy with azacitidine vs induction chemotherapy and posttransplantation outcome in patients with MDS.
Pretransplantation therapy with azacitidine vs induction chemotherapy and posttransplantation outcome in patients with MDS.
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DOI：
10.1016/j.bbmt.2012.01.009
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发表时间：
2012-08
影响因子：
4.3
通讯作者：
Scott, Bart L.
中科院分区：
文献类型：
--
作者：
Gerds, Aaron T.;Gooley, Ted A.;Estey, Elihu H.;Appelbaum, Frederick R.;Deeg, H. Joachim;Scott, Bart L.
关键词：
虽然异基因造血细胞移植（HCT）已被证明具有治疗骨髓增生异常综合征（MDS）的潜力，但HCT后复发仍然是一个问题。移植前细胞减灭联合诱导化疗（IC）已被用于降低复发率，但与显著的毒性和死亡率相关。低甲基化药物可实现细胞减少，毒性有限;然而，关于HCT前低甲基化对HCT后结局影响的数据有限。我们回顾性分析了68例接受异基因HCT治疗MDS或MDS转化的急性髓系白血病（AML）患者的结果。35例患者在HCT前接受了阿扎胞苷细胞减灭术，采用高剂量（40%）或低强度（60%）预处理方案，33例患者在HCT前接受了IC，采用高剂量预处理。阿扎胞苷组和IC组的估计1年总生存率分别为57%和36%。与IC组相比，阿扎胞苷组的HCT后死亡（HR 0.68，95% CI 0.35-1.30）、非复发死亡（HR 0.99，95% CI 0.41-2.34）和复发（HR 0.34，95% CI 0.41-2.34）风险较低，但仅复发风险显著较低。校正细胞遗传学风险、IPSS和供体后，两个队列的HCT后复发率相似。虽然目前的研究是回顾性的，非随机的，需要在这种情况下进行解释，结果增加了越来越多的证据表明，前HCT治疗阿扎胞苷与IC的毒性较低，并可能允许类似的后HCT的结果。
While allogeneic hematopoietic cell transplantation (HCT) has proven curative potential for myelodysplastic syndrome (MDS), relapse after HCT remains a problem. Pre-transplant cytoreduction with induction chemotherapy (IC) has been utilized to reduce relapse rates, but is associated with significant toxicity and mortality. Hypomethylating agents may achieve cytoreduction with limited toxicity; however, data on the effect of pre-HCT hypomethylation on post-HCT outcomes are limited. We retrospectively reviewed results in 68 patients who underwent allogeneic HCT for MDS or acute myeloid leukemia (AML) transformed from MDS. Thirty-five patients had received cytoreduction with azacitidine prior to HCT with either a high-dose (40%) or a reduced-intensity (60%) conditioning regimen, and 33 had undergone IC prior to HCT with high-dose conditioning. The estimated one-year overall survival was 57% in the azacitidine group and 36% in the IC group. The risk of post-HCT mortality (HR 0.68, 95% CI 0.35–1.30), non-relapse mortality (HR 0.99, 95% CI 0.41–2.34), and relapse (HR 0.34, 95% CI 0.41–2.34) were lower in the azacitidine group compared to the IC group, but only the hazard for relapse was significantly lower. After adjustment for cytogenetic risk, IPSS, and donor, the rates of post-HCT relapse for the two cohorts were similar. While the current study was retrospective and non-randomized and needs to be interpreted in this context, the results add to the growing evidence that pre-HCT therapy with azacitidine is associated with less toxicity than IC, and may allow for similar post-HCT outcomes.
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DOI：
10.1016/j.bbmt.2008.12.497
发表时间：
2009-03
期刊：
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
影响因子：
--
作者：
Giralt S;Ballen K;Rizzo D;Bacigalupo A;Horowitz M;Pasquini M;Sandmaier B
通讯作者：
Sandmaier B
DOI：
10.1016/j.hoc.2010.02.003
发表时间：
2010-04
期刊：
Hematology/oncology clinics of North America
影响因子：
--
作者：
Bartenstein M;Deeg HJ
通讯作者：
Deeg HJ
影响因子：
20.3
作者：
Goodyear, Oliver;Agathanggelou, Angelo;Craddock, Charles
通讯作者：
Craddock, Charles
影响因子：
3.1
作者：
Aggerholm, A;Holm, MS;Hokland, P
通讯作者：
Hokland, P
DOI：
10.6004/jnccn.2011.0005
发表时间：
2011-01
期刊：
Journal of the National Comprehensive Cancer Network : JNCCN
影响因子：
--
作者：
Greenberg PL;Attar E;Bennett JM;Bloomfield CD;De Castro CM;Deeg HJ;Foran JM;Gaensler K;Garcia-Manero G;Gore SD;Head D;Komrokji R;Maness LJ;Millenson M;Nimer SD;O'Donnell MR;Schroeder MA;Shami PJ;Stone RM;Thompson JE;Westervelt P;National Comprehensive Cancer Network
通讯作者：
National Comprehensive Cancer Network