Treatment, risk factors, and outcome of adults with relapsed AML after reduced intensity conditioning for allogeneic stem cell transplantation
Treatment, risk factors, and outcome of adults with relapsed AML after reduced intensity conditioning for allogeneic stem cell transplantation
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DOI：
10.1182/blood-2011-08-375840
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发表时间：
2012-02-09
期刊：
影响因子：
20.3
通讯作者：
Mohty, Mohamad
中科院分区：
文献类型：
--
作者：
Schmid, Christoph;Labopin, Myriam;Mohty, Mohamad
由于关于异基因造血干细胞移植（HSCT）联合低强度预处理（RIC）后AML复发的管理和结局的信息很少，EBMT的急性白血病工作组进行了一项回顾性登记研究。在1999年至2008年期间为AML完全缓解（CR）进行的2815例RIC移植中，累积复发率为32% +/-1%。复发患者（263例）被纳入总生存期（OS）风险因素的详细分析和预后评分的建立。CR率为32%，移植后缓解持续时间是唯一的预后因素（P = 0.003）。估计复发后2年OS为14%，因此与标准预处理后AML复发的结果相似。在复发时可用的变量中，HSCT后缓解> 5个月（风险比[HR] = 0.50，95%置信区间[CI]，0.37-0.67，P <0.001），骨髓原始细胞低于27%（HR = 0.53，95%CI，0.40-0.72，P < .001），HSCT后无急性GVHD（HR = 0.67，95%CI，0.49-0.93，P = 0.017）与更好的OS相关。基于这些因素，可以区分3个预后组，显示2年OS为32% +/-7%、19% +/-4%和4% +/- 2%（P < .0001）。长期生存几乎完全是在通过细胞减灭治疗成功诱导CR后，然后通过供体淋巴细胞输注或第二次HSCT进行巩固。（血。2012;119（6）：1599-1606）
Because information on management and outcome of AML relapse after allogeneic hematopoietic stem cell transplantation (HSCT) with reduced intensity conditioning (RIC) is scarce, a retrospective registry study was performed by the Acute Leukemia Working Party of EBMT. Among 2815 RIC transplants performed for AML in complete remission (CR) between 1999 and 2008, cumulative incidence of relapse was 32% +/- 1%. Relapsed patients (263) were included into a detailed analysis of risk factors for overall survival (OS) and building of a prognostic score. CR was reinduced in 32%; remission duration after transplantation was the only prognostic factor for response (P = .003). Estimated 2-year OS from relapse was 14%, thereby resembling results of AML relapse after standard conditioning. Among variables available at the time of relapse, remission after HSCT > 5 months (hazard ratio [HR] = 0.50, 95% confidence interval [CI], 0.37-0.67, P < .001), bone marrow blasts less than 27% (HR = 0.53, 95% CI, 0.40-0.72, P < .001), and absence of acute GVHD after HSCT (HR = 0.67, 95% CI, 0.49-0.93, P = .017) were associated with better OS. Based on these factors, 3 prognostic groups could be discriminated, showing OS of 32% +/- 7%, 19% +/- 4%, and 4% +/- 2% at 2 years (P < .0001). Long-term survival was achieved almost exclusively after successful induction of CR by cytoreductive therapy, followed either by donor lymphocyte infusion or second HSCT for consolidation. (Blood. 2012;119(6):1599-1606)