欧洲血液与骨髓移植合作组的一项回顾性研究：急性髓细胞白血病伴16号染色体倒位或t(8;21)首次缓解期患者自体或基因相同的异基因造血干细胞移植后的相同结局
Identical outcome after autologous or allogeneic genoidentical hematopoietic stem-cell transplantation in first remission of acute myelocytic leukemia carrying inversion 16 or t(8;21): a retrospective study from the European Cooperative Group for Blood and Marrow Transplantation.
作者信息
Gorin Norbert-Claude, Labopin Myriam, Frassoni Francesco, Milpied Noel, Attal Michel, Blaise Didier, Meloni Giovanna, Iori Anna P, Michallet Mauricette, Willemze Roel, Deconninck Eric, Harousseau Jean-Luc, Polge Emmanuelle, Rocha Vanderson
机构信息
Department of Hematology, Hopital Saint-Antoine and Université Pierre et Marie Curie UPMC, 184 Rue du Faubourg Saint-Antoine, Cedex 12 Paris, France.
出版信息
J Clin Oncol. 2008 Jul 1;26(19):3183-8. doi: 10.1200/JCO.2007.15.3106. Epub 2008 May 27.
PURPOSE
Patients with acute myelocytic leukemia carrying inversion 16 (inv16) or t(8;21) have a better initial response to high-dose cytarabine than patients without these chromosomal abnormalities. They presently do not undergo transplantation in first remission (CR1), but there is concern about late relapses.
PATIENTS AND METHODS
From 1990 to 2004, 325 adult patients received transplantations in CR1 (159 patients with inv16 and 166 patients with t(8;21), including 35 and 60 patients, respectively, with additional chromosomal abnormalities). Genoidentical allografts were performed in 64 patients with inv16 and 81 patients with t(8;21), and autografts were performed in 95 patients with inv16 and 85 patients with t(8;21).
RESULTS
In patients with inv16, after allogeneic and autologous transplantation, the 5-year leukemia-free survival (LFS) rates were 59% and 66% (P = .5), the relapse incidence (RI) rates were 27% and 32% (P = .45), and the transplantation-related mortality (TRM) rates were 14% and 2% (P = .003), respectively. Female patients had a lower RI and a higher LFS. Additional chromosomal abnormalities, compared with no additional abnormalities, were associated with lower RI rate (12% v 34%, respectively; P = .01) and higher 5-year LFS rate (78% v 59%, respectively; P = .04). In patients with t(8;21), after allogeneic and autologous transplantation, the 5-year LFS rates were 60% and 66% (P = .69), the RI rates were 15% and 28% (P = .03), and the TRM rates were 24% and 6% (P = .003), respectively. Younger age and a lower WBC count at diagnosis were associated with a lower TRM and a better LFS. The TRM was lower and the RI was higher in patients with autologous transplantations versus allogeneic transplantations.
CONCLUSION
Both autologous and allogeneic transplantation resulted in similar outcomes.
目的
与无这些染色体异常的患者相比，携带16号染色体倒位（inv16）或t(8;21)的急性髓细胞白血病患者对大剂量阿糖胞苷的初始反应更好。目前，他们在首次缓解期（CR1）不进行移植，但人们担心会出现晚期复发。
患者与方法
1990年至2004年，325例成年患者在CR1期接受了移植（159例inv16患者和166例t(8;21)患者，分别包括35例和60例伴有其他染色体异常的患者）。64例inv16患者和81例t(8;21)患者进行了同基因异体移植，95例inv16患者和85例t(8;21)患者进行了自体移植。
结果
在inv16患者中，异基因移植和自体移植后，5年无白血病生存率（LFS）分别为59%和66%（P = 0.5），复发率（RI）分别为27%和32%（P = 0.45），移植相关死亡率（TRM）分别为14%和2%（P = 0.003）。女性患者的RI较低，LFS较高。与无其他异常相比，伴有其他染色体异常与较低的RI率（分别为12%对34%；P = 0.01）和较高的5年LFS率（分别为78%对59%；P = 0.04）相关。在t(8;21)患者中，异基因移植和自体移植后，5年LFS率分别为60%和66%（P = 0.69），RI率分别为15%和28%（P = 0.03），TRM率分别为24%和从6%（P = 0.003）。诊断时年龄较小和白细胞计数较低与较低的TRM和较好的LFS相关。与异基因移植相比，自体移植患者的TRM较低，RI较高。
结论
自体移植和异基因移植的结果相似。
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