A decision analysis of allogeneic hematopoietic stem cell transplantation in adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia in first remission who have an HLA-matched sibling donor
A decision analysis of allogeneic hematopoietic stem cell transplantation in adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia in first remission who have an HLA-matched sibling donor
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DOI：
10.1038/leu.2010.260
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发表时间：
2011-02-01
期刊：
影响因子：
11.4
通讯作者：
Kanda, Y.
中科院分区：
文献类型：
--
作者：
Kako, S.;Morita, S.;Kanda, Y.
使用遗传随机化的临床研究不能准确回答具有人类白细胞抗原（HLA）匹配的同胞的费城染色体阴性急性淋巴细胞白血病（ALL）成人患者是否应该在首次缓解时接受异基因造血干细胞移植（HSCT）或化疗，因为在这些研究中，没有同胞供体的患者在复发后接受替代供体移植或单独化疗。因此，我们进行了决策分析，以确定在这种情况下的最佳策略。根据日本成人白血病研究组的前瞻性研究、日本造血细胞移植学会数据库和文献估计转移概率和效用。主要结果指标是10年生存概率，有或没有生活质量（QOL）调整。根据基于白色血细胞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。在未调整QOL的分析中，在整个人群（48.3% vs 32.6%）和所有亚组中，首次缓解时同种异体HSCT的疗效优于HSCT（上级）。通过QOL调整，保持了类似的趋势（在整个人群中为44.9% vs 31.7%）。为了提高长期生存的可能性，对于有HLA匹配同胞的患者，建议在首次缓解时进行异基因HSCT。Leukemia（2011）25，259 - 265; doi：10.1038/leu.2010.260; 2010年11月12日在线发表
Clinical studies using genetic randomization cannot accurately answer whether adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia (ALL) who have a human leukocyte antigen (HLA)-matched sibling should undergo allogeneic hematopoietic stem cell transplantation (HSCT) or chemotherapy in first remission, as, in these studies, patients without a sibling donor undergo alternative donor transplantation or chemotherapy alone after a relapse. Therefore, we performed a decision analysis to identify the optimal strategy in this setting. Transition probabilities and utilities were estimated from prospective studies of the Japan Adult Leukemia Study Group, the database of the Japan Society for Hematopoietic Cell Transplantation and the literature. The primary outcome measure was the 10-year survival probability with or without quality of life (QOL) adjustments. Subgroup analyses were performed according to risk stratification on the basis of white blood cell count and cytogenetics, and according to age stratification. In analyses without QOL adjustments, allogeneic HSCT in first remission was superior in the whole population (48.3 vs 32.6%) and in all subgroups. With QOL adjustments, a similar tendency was conserved (44.9 vs 31.7% in the whole population). To improve the probability of long-term survival, allogeneic HSCT in first remission is recommended for patients who have an HLA-matched sibling. Leukemia (2011) 25, 259-265; doi:10.1038/leu.2010.260; published online 12 November 2010