Outcome predictors after retransplantation in relapsed acute lymphoblastic leukemia: a multicenter, retrospective study
Outcome predictors after retransplantation in relapsed acute lymphoblastic leukemia: a multicenter, retrospective study
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DOI：
10.1007/s00277-020-04310-0
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发表时间：
2020-11-05
影响因子：
3.5
通讯作者：
Miyamoto, Toshihiro
中科院分区：
文献类型：
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作者：
Mori, Yasuo;Sasaki, Kensuke;Miyamoto, Toshihiro
对于同种异体造血细胞移植（alloc - hct）后复发的急性淋巴细胞白血病（ALL）患者，再移植是唯一的治疗选择；然而，这方面的数据仍然很少。因此，这项多中心回顾性研究旨在确定复发ALL再移植后的预后预测因素。我们检查了在2006-2018年期间接受多次同种异体肝移植的55名受者。2年总生存率（OS）、无进展生存率（PFS）和非复发死亡率分别为35.9%、29.1%和23.6%。我们观察到Ph + ALL （n = 22）患者与非Ph ALL （n = 33）患者相比，预后有更好的趋势；2年PFS分别为40.9%和21.2%，表明更有效的第二代或第三代酪氨酸激酶抑制剂的有益作用。单因素分析显示，先前移植后的晚期复发是Ph + ALL患者移植预后较好的唯一显著预测因素，而非Ph ALL患者延长OS/PFS的因素是先前移植后的晚期复发，从疾病复发/进展到第二次或更多次同种异体hct的较长时间，移植时的疾病状态和良好的表现状态。然而，需要进一步的研究来确定具有更高疗效和更少毒性的新型分子靶向药物是否可以超越传统化疗作为下一个alloo - hct的桥接策略，并改善非ph ALL患者的预后。
Retransplantation is the only curative treatment option for patients with acute lymphoblastic leukemia (ALL) that has relapsed after allogeneic hematopoietic cell transplantation (allo-HCT); however, data in this setting remain scant. Hence, this multicenter, retrospective study aims to determine outcome predictors after retransplantation in relapsed ALL. We examined 55 recipients who underwent multiple allo-HCTs during 2006-2018. The 2-year overall survival (OS), progression-free survival (PFS), and non-relapse mortality rates were 35.9%, 29.1%, and 23.6%, respectively. We observed a trend of better outcome in Ph + ALL (n = 22) patients compared with non-Ph ALL (n = 33) patients; the 2-year PFS was 40.9% versus 21.2%, indicating a beneficial effect of more potent second- or third-generation tyrosine kinase inhibitors. Univariate analysis revealed that late relapse after the previous transplant was the only significant predictor of better transplant outcome among Ph + ALL patients, whereas factors related to prolonged OS/PFS in non-Ph ALL patients were late relapse after the previous transplant, longer duration from disease relapse/progression to second or more allo-HCT, disease status at the transplantation, and good performance status. Nevertheless, further investigations are warranted to determine whether novel molecular-targeted agents with higher efficacy and fewer toxicities could exceed conventional chemotherapies as a bridging strategy to next allo-HCT and improve the outcomes of non-Ph ALL patients.