Kim Dong Hwan, Sohn Sang Kyun, Kim Jong Gwang, Lee Nan Young, Sung Woo Jin, Baek Jin Ho, Suh Jang Soo, Lee Kun Soo, Lee Kyu Bo
Department of Hematology/Oncology, Kyungpook National University Hospital, Jung-gu, 700-721 Daegu, South Korea.
Ann Hematol. 2005 Jan;84(1):25-32. doi: 10.1007/s00277-004-0942-z. Epub 2004 Sep 3.
In addition to the clinical disease status at transplantation, the cytogenetic risk at presentation also provides critical information for predicting the prognosis or deciding the future therapeutic strategy. As such, the current study examined various parameters, including the cytogenetics at presentation and clinical disease status at transplantation, regarding their effect on the transplant outcomes of acute myeloid leukemia (AML) patients in an allogeneic peripheral blood stem cell transplantation (PBSCT) setting. A total of 36 patients receiving an allogeneic PBSCT from matched sibling donors were included in a state of first complete remission (CR) (n=22, 61%) or beyond the first CR (n=14, 39%). The cytogenetic risk was classified according to Medical Research Council (MRC) 10 criteria: favorable, 7 patients (20%); intermediate, 21 patients (58%); unfavorable eight patients (22%). The 3-year overall survival rates were 80% for the favorable, 63% for the intermediate, and 0% for the unfavorable cytogenetic risk groups (p=0.0002), and 62% for the patients in a state of first CR and 35% for those beyond the first CR (p=0.0524). Multivariate analysis revealed that higher CD34+ cell doses, favorable cytogenetics at presentation, and a lower marrow blast percentage at transplantation were all strongly associated with favorable transplant outcomes, including overall survival (OS), progression-free survival (PFS), and the probability of progression. The cytogenetic risk at presentation was found to be a useful parameter in predicting the transplant outcomes for patients with AML, regardless of the clinical disease status. However, an additive innovative therapeutic strategy is still needed to overcome an unfavorable cytogenetic risk with refractory AML after allogeneic PBSCT.
除了移植时的临床疾病状态外，初诊时的细胞遗传学风险也为预测预后或决定未来治疗策略提供了关键信息。因此，本研究在异基因外周血干细胞移植（PBSCT）背景下，考察了包括初诊时的细胞遗传学和移植时的临床疾病状态等各种参数对急性髓系白血病（AML）患者移植结局的影响。共有36例接受来自同胞匹配供体的异基因PBSCT的患者，处于首次完全缓解（CR）状态（n = 22，61%）或首次CR之后（n = 14，39%）。细胞遗传学风险根据医学研究委员会（MRC）10标准分类：良好，7例患者（20%）；中等，21例患者（58%）；不良，8例患者（22%）。细胞遗传学风险良好组、中等组和不良组的3年总生存率分别为80%、63%和0%（p = 0.0002），首次CR状态患者为62%，首次CR之后患者为35%（p = 0.0524）。多变量分析显示，较高的CD34+细胞剂量、初诊时良好的细胞遗传学以及移植时较低的骨髓原始细胞百分比均与良好的移植结局密切相关，包括总生存（OS）、无进展生存（PFS）和进展概率。结果发现，无论临床疾病状态如何，初诊时的细胞遗传学风险都是预测AML患者移植结局的一个有用参数。然而，仍需要一种附加的创新治疗策略来克服异基因PBSCT后难治性AML的不良细胞遗传学风险。
