The role of HLA-matched unrelated transplantation in adult patients with Ph chromosome-negative ALL in first remission. A decision analysis.
The role of HLA-matched unrelated transplantation in adult patients with Ph chromosome-negative ALL in first remission. A decision analysis.
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HLA 匹配的无关移植在首次缓解的 Ph 染色体阴性 ALL 成年患者中的作用。
DOI：
10.1038/bmt.2013.4
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发表时间：
2013
影响因子：
4.8
通讯作者：
Kako S
中科院分区：
文献类型：
--
作者：
Miyamoto T;Yoshimoto G;Kamimura T;Muta T;Takashima S;Ito Y;Shiratsuchi M;Choi I;Kato K;Takenaka K;Iwasaki H;Takamatsu Y;Teshima T;Akashi K.;長谷川敦史,金子寛,山本雅之,清水律子;岩崎俊晴，Ronny Lesmana，下川哲昭，鯉淵典之;Kako S
无关移植对缺乏HLA匹配同胞的ALL患者的疗效尚不清楚。我们进行了一项决策分析，以确定从遗传学上HLA-A，-B，-DRB 1等位基因匹配的无关供体进行清髓性移植治疗年龄21-54岁的Ph染色体阴性ALL患者的疗效。根据日本成人白血病研究组研究（ALL 93; n= 80，ALL 97; n= 82）和日本骨髓供体计划数据库（首次CR（CR 1）移植：n= 177）估计转移概率。主要结果指标是10年生存概率，有或没有生活质量（QOL）调整。根据基于WBC计数和细胞遗传学的风险分层以及根据年龄分层进行亚组分析。在所有患者中，在有和没有QOL调整的分析中，CR 1的无关移植显示出上级优势（分别为40.8 vs 28.4%和43.9 vs 29.0%）。在所有亚组中观察到类似的趋势。决策模型对化疗后无白血病生存的概率和标准风险和较高年龄患者移植后生存的概率敏感。CR 1患者的非亲缘移植可提高缺乏HLA匹配同胞的患者的长期生存概率然而，最近治疗策略的改进可能会改变这一结果。
The efficacy of unrelated transplantation for patients with ALL who lack an HLA-matched sibling remains unclear. We performed a decision analysis to determine the efficacy of myeloablative transplantation from a genetically HLA-A,-B,-DRB1 allele-matched unrelated donor for patients with Ph chromosome-negative ALL aged 21–54 years. The transition probabilities were estimated from the Japan Adult Leukemia Study Group studies (ALL93; n= 80, ALL97; n= 82), and the Japan Marrow Donor Program database (transplantation in first CR (CR1): n= 177). The primary outcome measure was the 10-year survival probability with or without quality of life (QOL) adjustment. Subgroup analyses were performed according to risk stratification based on the WBC count and cytogenetics, and according to age stratification. In all patients, unrelated transplantation in CR1 was shown to be superior in analyses both with and without QOL adjustment (40.8 vs 28.4% and 43.9 vs 29.0%, respectively). A similar tendency was observed in all subgroups. The decision model was sensitive to the probability of leukemia-free survival following chemotherapy and the probability of survival after transplantation in standard-risk and higher-aged patients. Unrelated transplantation in CR1 improves the long-term survival probability in patients who lack an HLA-matched sibling. However, recent improvements in treatment strategies may change this result.