Myeloablative Haploidentical Transplantation Is Superior to Chemotherapy for Patients with Intermediate- risk Acute Myelogenous Leukemia in First Complete Remission
Myeloablative Haploidentical Transplantation Is Superior to Chemotherapy for Patients with Intermediate- risk Acute Myelogenous Leukemia in First Complete Remission
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对于首次完全缓解的中危急性髓性白血病患者，清髓性单倍相合移植优于化疗
DOI：
10.1158/1078-0432.ccr-18-1637
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发表时间：
2019-03-15
影响因子：
11.5
通讯作者：
Huang, Xiao-Jun
中科院分区：
文献类型：
--
作者：
Lv, Meng;Wang, Yu;Huang, Xiao-Jun
目的:尽管移植前抗胸腺细胞球蛋白（ATG）和粒细胞集落刺激因子（G-CSF）刺激的移植物（ATG+G-CSF）后的清髓性HLA单倍相同造血干细胞移植（haploi -HSCT）已被证实是HLA匹配的兄弟姐妹供体（MSD） HSCT的替代方法，单倍造血干细胞移植对首次完全缓解（CR1）的中度危险急性髓系白血病（AML）患者缓解后治疗的影响尚未明确。患者和方法：在这项前瞻性试验中，在443例年龄16-60岁的新诊断的具有风险细胞遗传学的新生AML患者中，147例分子风险AML患者在两个诱导疗程内达到CR1，并在缓解后4个月仍保持CR1，要么接受化疗（n = 69），要么接受单倍造血干细胞移植（n = 78）。结果：单倍造血干细胞移植组3年无白血病生存期（LFS）和总生存期（OS）显著高于化疗组（74.3% vs. 47.3%, P = 0.0004和80.8% vs. 53.5%, P = 0.0001）。在倾向评分调整的多变量分析中，缓解后治疗（单倍造血干细胞移植vs化疗）是影响LFS的独立危险因素[HR 0.360；95%置信区间（CI）， 0.163-0.793；P = 0.011]，总生存率（HR 0.361; 95% CI, 0.156-0.832; P = 0.017），以及累积复发率（HR 0.161; 95% CI, 0.057-0.459; P = 0.001），无论是在整个队列中还是在第二次巩固后按最小残留疾病分层。结论：ATG+G-CSF的清髓单倍hsct作为急性急性髓细胞白血病（AML）缓解后治疗优于化疗。在没有HLA-MSDs的情况下，单倍造血干细胞移植可能是治疗急性髓系白血病缓解后的一线治疗方法。单倍造血干细胞移植（Haplo-HSCT）作为CR1中危AML缓解后的一线治疗可能优于化疗。
Purpose: Although myeloablative HLA haploidentical hematopoietic stem cell transplantation (haplo-HSCT) following pretransplant anti-thymocyte globulin (ATG) and granulocyte colony-stimulating factor (G-CSF) stimulated grafts (ATG+G-CSF) has been confirmed as an alternative to HSCT from HLA-matched sibling donors (MSD), the effect of haplo-HSCT on postremission treatment of patients with acute myeloid leukemia (AML) with intermediate risk (int-risk AML) who achieved first complete remission (CR1) has not been defined.Patients and Methods: In this prospective trial, among 443 consecutive patients ages 16-60 years with newly diagnosed de novo AML with int-risk cytogenetics, 147 patients with molecular int-risk AML who achieved CR1 within two courses of induction and remained in CR1 at 4 months postremission either received chemotherapy (n = 69) or underwent haplo-HSCT (n = 78).Results: The 3-year leukemia-free survival (LFS) and overall survival (OS) were significantly higher in the haplo-HSCT group than in the chemotherapy group (74.3% vs. 47.3%; P = 0.0004 and 80.8% vs. 53.5%; P = 0.0001, respectively). In the multivariate analysis with propensity score adjustment, postremission treatment (haplo-HSCT vs. chemotherapy) was an independent risk factor affecting the LFS [HR 0.360; 95% confidence interval (CI), 0.163-0.793; P = 0.011], OS (HR 0.361; 95% CI, 0.156-0.832; P = 0.017), and cumulative incidence of relapse (HR 0.161; 95% CI, 0.057-0.459; P = 0.001) either in entire cohort or stratified by minimal residual disease after the second consolidation.Conclusions: Myeloablative haplo-HSCT with ATG+G-CSF is superior to chemotherapy as a postremission treatment in patients with int-risk AML during CR1. Haplo-HSCT might be a first-line postremission therapy for int-risk AML in the absence of HLA-MSDs. Haplo-HSCT might be superior to chemotherapy as a first-line postremission treatment of intermediate-risk AML in CR1.