Persistence of Cytogenetic Abnormalities at Complete Remission After Induction in Patients With Acute Myeloid Leukemia: Prognostic Significance and the Potential Role of Allogeneic Stem-Cell Transplantation
Persistence of Cytogenetic Abnormalities at Complete Remission After Induction in Patients With Acute Myeloid Leukemia: Prognostic Significance and the Potential Role of Allogeneic Stem-Cell Transplantation
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DOI：
10.1200/jco.2010.34.2873
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发表时间：
2011-06-20
影响因子：
45.3
通讯作者：
Ravandi, Farhad
中科院分区：
文献类型：
--
作者：
Chen, Yiming;Cortes, Jorge;Ravandi, Farhad
目的探讨急性髓系白血病（AML）患者完全缓解（CR）时持续性细胞遗传学异常对无复发生存期（RFS）和总生存期（OS）的预后影响，并探讨异基因干细胞移植（SCT）在这种情况下的潜在作用。（不包括急性早幼粒细胞白血病）谁达到CR诱导化疗后的各种一线protocols.ResultsMedian随访生存患者为43个月。与CR时细胞遗传学正常的患者（n = 183）相比，CR时细胞遗传学异常的患者（n = 71）的RFS（P = 0.001）和OS（P <0.001）显著缩短; 3年RFS分别为15%和45%，3年OS分别为15%和56%。在CR时存在持续性细胞遗传学异常的患者中，首次CR时接受SCT的患者（CR 1; n = 15）的RFS和OS优于未接受SCT的患者（n = 56; P分别为0.04和0.06）。在多变量分析中，CR时持续的细胞遗传学异常是RFS的独立预测因素（P <0.001）和OS（P = .001），但在CR时持续细胞遗传学异常的患者中，OS无显著差异在接受或未接受SCT的患者之间观察到（P = 0.25），有支持SCT治疗RFS的趋势结论CR时持续的细胞遗传学异常细胞预示着RFS和OS显著缩短。CR 1期SCT可能改善诱导后缺乏细胞遗传学缓解的患者的临床结局，尽管这取决于患者的选择。J Clin Oncol 29：2507-2513. (C)2011年美国临床肿瘤学会
PurposeTo determine the prognostic impact of persistent cytogenetic abnormalities at complete remission (CR) on relapse-free survival (RFS) and overall survival (OS) in patients with acute myeloid leukemia (AML) and to examine the potential role of allogeneic stem-cell transplantation (SCT) in this setting.Patients and MethodsData from 254 adult patients with AML (excluding acute promyelocytic leukemia) who achieved CR after induction chemotherapy on various first-line protocols were examined.ResultsMedian follow-up for surviving patients was 43 months. Patients with cytogenetic abnormalities at CR (n = 71) had significantly shorter RFS (P = .001) and OS (P < .001) compared with patients with normal cytogenetics at CR (n = 183); 3-year RFS was 15% and 45%, and 3-year OS was 15% and 56%, respectively. Among the patients with persistent cytogenetic abnormalities at CR, those who underwent SCT in first CR (CR1; n = 15) had better RFS and OS compared to those without SCT (n = 56; P = .04 and .06, respectively). In multivariate analysis, persistent cytogenetic abnormalities at CR was an independent predictor for RFS (P < .001) and OS (P = .001), but among patients with persistent cytogenetic abnormalities at CR, no significant differences in OS (P = .25) was observed between those who did or did not receive SCT with a trend favoring SCT for RFS (P = .08).ConclusionPersistent cytogenetically abnormal cells at CR predict a significantly shorter RFS and OS. SCT in CR1 may improve the clinical outcome of patients lacking cytogenetic remission after induction although this depends on patient selection. J Clin Oncol 29:2507-2513. (C) 2011 by American Society of Clinical Oncology