Prospective Evaluation of Allogeneic Hematopoietic Stem-Cell Transplantation From Matched Related and Matched Unrelated Donors in Younger Adults With High-Risk Acute Myeloid Leukemia: German-Austrian Trial AMLHD98A
Prospective Evaluation of Allogeneic Hematopoietic Stem-Cell Transplantation From Matched Related and Matched Unrelated Donors in Younger Adults With High-Risk Acute Myeloid Leukemia: German-Austrian Trial AMLHD98A
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DOI：
10.1200/jco.2010.28.6856
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发表时间：
2010-10-01
影响因子：
45.3
通讯作者：
Doelmer, Hartmut
中科院分区：
文献类型：
--
作者：
Schlenk, Richard F.;Doehner, Konstanze;Doelmer, Hartmut
目的在一项前瞻性多中心治疗试验中，评估来自匹配相关供体（MRDs）和匹配非相关供体（MUDs）的异体造血干细胞移植（HSCT）对高危急性髓性白血病（AML）患者预后的影响。患者和方法在1998年至2004年期间，844例AML患者（中位年龄48岁，范围16至62岁）被纳入AMLHD98A方案，该方案包括风险适应治疗策略。高风险被定义为存在不利的细胞遗传学和/或对诱导治疗无反应。结果844例患者中有267例（32%）被归为高危组。在这267例患者中，51例患者（19%）达到完全缓解，但有不良的细胞遗传学，216例患者（81%）对诱导治疗无反应。在确诊后147天的中位时间后，267名高危患者中有162名（61%）接受了同种异体造血干细胞移植。移植来源：MRD (n = 62), MUD (n = 89)，单倍体供体（n = 10），脐带血（n = 1）。未进行HSCT的患者（n = 105）的5年总生存率为6.5% (95% CI, 3.1% - 13.6%)，接受HSCT的患者（n = 162）的5年总生存率为25.1% （95% CI, 19.1% - 33.0%；从移植之日起）。包括异基因造血干细胞移植作为时间相关协变量在内的多变量分析显示，异基因造血干细胞移植显著改善了预后；来自MRD和MUD的同种异体造血干细胞移植的结果没有差异。结论：年轻成人高风险AML患者的同种异体造血干细胞移植对预后有显著的有益影响，MRD和MUD的同种异体造血干细胞移植产生相似的结果。
PurposeTo assess the impact of allogeneic hematopoietic stem-cell transplantation (HSCT) from matched related donors (MRDs) and matched unrelated donors (MUDs) on outcome in high-risk patients with acute myeloid leukemia (AML) within a prospective multicenter treatment trial.Patients and MethodsBetween 1998 and 2004, 844 patients (median age, 48 years; range, 16 to 62 years) with AML were enrolled onto protocol AMLHD98A that included a risk-adapted treatment strategy. High risk was defined by the presence of unfavorable cytogenetics and/or by no response to induction therapy.ResultsTwo hundred sixty-seven (32%) of 844 patients were assigned to the high-risk group. Of these 267 patients, 51 patients (19%) achieved complete remission but had adverse cytogenetics, and 216 patients (81%) had no response to induction therapy. Allogeneic HSCT was actually performed in 162 (61%) of 267 high-risk patients, after a median time of 147 days after diagnosis. Graft sources were as follows: MRD (n = 62), MUD (n = 89), haploidentical donor (n = 10), and cord blood (n = 1). The 5-year overall survival rates were 6.5% (95% CI, 3.1% to 13.6%) for patients (n = 105) not proceeding to HSCT and 25.1% (95% CI, 19.1% to 33.0%; from date of transplantation) for patients (n = 162) receiving HSCT. Multivariable analysis including allogeneic HSCT as a time-dependent covariable revealed that allogeneic HSCT significantly improved outcome; there was no difference in outcome between allogeneic HSCT from MRD and MUD.ConclusionAllogeneic HSCT in younger adults with high-risk AML has a significant beneficial impact on outcome, and allogeneic HSCT from MRD and MUD yields similar results.