Mathews Vikram, DiPersio John F
Division of Oncology/Section of BMT and Leukemia, Sireman Cancer Center, Washington University School of Medicine, Campus Box 8056, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
Curr Hematol Rep. 2004 Jul;3(4):235-41.
Most newly diagnosed patients with acute myeloid leukemia (AML) in first remission will relapse without additional consolidation therapy. The options for consolidation therapy include repeated cycles of high-dose cytosine arabinoside-based chemotherapy and autologous or allogeneic stem cell transplantation (SCT). Chemotherapy alone is associated with the highest risk of relapse, but it has the lowest treatment-related mortality (TRM). Allogeneic SCT has the lowest risk of relapse with the highest TRM, whereas autologous SCT has an intermediate risk of relapse and TRM. Cytogenetic status of patients with AML is the single most important prognostic factor. However, it is increasingly recognized that this factor alone is inadequate for risk stratification. Based on cytogenetic stratification, a good-risk group of patients in first complete remission (CR1) would benefit most from high-dose consolidation chemotherapy. The risks of a SCT outweigh the benefit in this group. In the unfavorable-risk group, an allogeneic sibling SCT in CR1 would be acceptable, whereas the outcomes with chemotherapy alone or with an autologous SCT are dismal. Based on minimal data, a matched-unrelated donor SCT for this group of patients should be recommended. In the intermediate-risk group, strategies are evolving and the use of additional prognosticators will help in decision making. Autologous or allogeneic sibling SCT is a reasonable option in a subset of patients within this group at a high risk of relapse. There are insufficient data to recommend a haploidentical or cord blood transplant for patients with AML in CR1.
大多数新诊断的急性髓系白血病（AML）患者首次缓解后若不进行额外的巩固治疗将会复发。巩固治疗的选择包括基于大剂量阿糖胞苷的化疗重复疗程以及自体或异基因干细胞移植（SCT）。单纯化疗复发风险最高，但治疗相关死亡率（TRM）最低。异基因SCT复发风险最低但TRM最高，而自体SCT的复发风险和TRM处于中等水平。AML患者的细胞遗传学状态是最重要的单一预后因素。然而，人们越来越认识到仅这一因素不足以进行风险分层。基于细胞遗传学分层，首次完全缓解（CR1）的低危组患者从大剂量巩固化疗中获益最大。该组患者进行SCT风险大于获益。在高危组中，CR1时进行异基因同胞SCT是可以接受的，而单纯化疗或自体SCT的预后都很差。基于有限的数据，应推荐为该组患者进行匹配无关供者SCT。在中危组，策略正在不断发展，使用更多的预后指标将有助于决策。自体或异基因同胞SCT对于该组中复发风险高的部分患者是合理的选择。对于CR1的AML患者，没有足够的数据推荐单倍体相合或脐血移植。
