Kalaycio Matt, Advani Anjali, Pohlman Brad, Sekeres Mikkael, Tripp Barbara, Rybicki Lisa, Sobecks Ronald
Department of Hematologic Malignancies and Blood Disorders, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio 44195, USA.
Am J Hematol. 2008 Nov;83(11):831-4. doi: 10.1002/ajh.21260.
Cytogenetic analysis at the time of diagnosis predicts outcome in patients with acute myelogenous leukemia (AML). For those patients with favorable risk cytogenetics, stem cell transplant can be delayed until the time of relapse. For those patients with nonfavorable cytogenetic risk profiles, stem cell transplant may be required for optimal survival benefit. We treated patients with de novo AML and age less than 60 years first with etoposide, mitoxantrone, cytarabine, and G-CSF (EMA-G) to induce remission. Patients in complete remission were assigned to treatment with chemotherapy alone if they had favorable risk cytogenetics defined as the identification of a core-binding factor translocation. Patients with any other cytogenetic profile were assigned to treatment with either autologous or allogeneic stem cell transplant depending on the availability of an HLA-matched donor. Following EMA-G, 33 of 40 patients (83%) achieved CR. Of the 25 patients who actually were treated with postremission chemotherapy, 21 were treated with their assigned risk-adapted therapy. Of the 33 patients in remission, 5 year relapse-free survival (RFS) and overall survival (OS) was 46 and 38%, respectively. Our intensive and risk-adapted, stem cell transplant approach to the treatment of patients with AML requires a better definition of risk and does not appear to substantially improve results compared with more standard approaches.
急性髓性白血病（AML）患者诊断时的细胞遗传学分析可预测预后。对于细胞遗传学风险良好的患者，干细胞移植可推迟至复发时进行。对于细胞遗传学风险特征不佳的患者，可能需要进行干细胞移植以获得最佳生存获益。我们首先用依托泊苷、米托蒽醌、阿糖胞苷和粒细胞集落刺激因子（EMA-G）治疗初发AML且年龄小于60岁的患者以诱导缓解。完全缓解的患者如果细胞遗传学风险良好（定义为存在核心结合因子易位），则分配至单纯化疗组。具有任何其他细胞遗传学特征的患者根据是否有HLA匹配供体分配至自体或异基因干细胞移植组。接受EMA-G治疗后，40例患者中有33例（83%）达到完全缓解（CR）。在实际接受缓解后化疗的25例患者中，21例接受了根据风险调整的指定治疗。在33例缓解患者中，5年无复发生存率（RFS）和总生存率（OS）分别为46%和38%。我们对AML患者采用的强化且根据风险调整的干细胞移植治疗方法需要更好地界定风险，与更标准的方法相比，似乎并未显著改善治疗结果。
