Similar Overall Survival Using Sibling, Unrelated Donor, and Cord Blood Grafts after Reduced-Intensity Conditioning for Older Patients with Acute Myelogenous Leukemia
Similar Overall Survival Using Sibling, Unrelated Donor, and Cord Blood Grafts after Reduced-Intensity Conditioning for Older Patients with Acute Myelogenous Leukemia
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DOI：
10.1016/j.bbmt.2013.06.006
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发表时间：
2013-09-01
影响因子：
4.3
通讯作者：
Weisdorf, Daniel
中科院分区：
文献类型：
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作者：
de Latour, Regis Peffault;Brunstein, Claudio G.;Weisdorf, Daniel
对于老年急性髓系白血病(AML)患者，异基因造血细胞移植(HCT)提供了最好的长期生存机会。在这种情况下，配型同胞(SIB)、无血缘关系的供者凝血或脐带血(UCB)移植之间的正式比较还没有报道。我们比较了连续197例50岁及以上的急性髓细胞白血病(AML)患者经SIB(n=82)、URD(n=35)或脐带血(n=80)移植后完全缓解的降低强度调节HCT。SIB、URD和UCB移植的3年累积死亡率分别为18%、14%和24%(P=0.22)。SIB、URD和UCB移植的3年无白血病生存率分别为48%、57%和33%(P=0.009)。在多变量分析中，低风险细胞遗传学与复发(风险比，1.7[95%可信区间，1.0至3.0]；P=.04)和较差的无白血病生存率(风险比，1.6[95%可信区间，1.0至2.5]；P=.03)相关，而供者的选择对总生存率没有显著影响(P=.73)。调整后的3年总生存率，SIB组为55%，URD组为45%，UCB移植组为43%(P=0.26)。在前瞻性研究完成之前，这项研究支持为完全缓解的老年AML患者考虑SIB供体、URD或UCB进行HCT的建议。(C)2013年美国血液和骨髓移植学会。爱思唯尔公司出版，版权所有。
For older patients with acute myeloid leukemia (AML), allogeneic hematopoietic cell transplantation (HCT) provides the best chance of long-term survival. A formal comparison between matched sibling (SIB), unrelated donor CURD), or umbilical cord blood (UCB) transplantation has not yet been reported in this setting. We compared reduced-intensity conditioning HCT in 197 consecutive patients 50 years and older with AML in complete remission from SIB (n = 82), URD (n = 35), or UCB (n = 80) transplantation. The 3-year cumulative incidences of transplantation-related mortality were 18%, 14%, and 24% with SIB, URD, and UCB transplantation, respectively (P = .22). The 3-year leukemia-free survival rates were 48%, 57%, and 33% with SIB, URD, and UCB transplantation, respectively (P = .009). In multivariate analysis, poor-risk cytogenetics was associated with relapse (hazard ratio, 1.7 [95% confidence interval, 1.0 to 3.0]; P = .04) and worse leukemia-free survival (hazard ratio, 1.6 [95% confidence interval, 1.0 to 2.5]; P = .03), whereas donor choice had no significant impact on overall survival (P = .73). Adjusted 3-year overall survival rates were 55% with SIB, 45% with URD, and 43% with UCB transplantation (P = .26). Until prospective studies are completed, this study supports the recommendation to consider SIB donor, URD, or UCB for HCT for older patients with AML in complete remission. (C) 2013 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.