Mayo Clinic Rochester, Rochester, MN, USA.
Blood. 2010 Mar 4;115(9):1850-7. doi: 10.1182/blood-2009-10-249128. Epub 2009 Dec 23.
Therapy-related myelodysplastic syndromes (t-MDSs) and acute myeloid leukemia (t-AML) have a poor prognosis with conventional therapy. Encouraging results are reported after allogeneic transplantation. We analyzed outcomes in 868 persons with t-AML (n = 545) or t-MDS (n = 323) receiving allogeneic transplants from 1990 to 2004. A myeloablative regimen was used for conditioning in 77%. Treatment-related mortality (TRM) and relapse were 41% (95% confidence interval [CI], 38-44) and 27% (24-30) at 1 year and 48% (44-51) and 31% (28-34) at 5 years, respectively. Disease-free (DFS) and overall survival (OS) were 32% (95% CI, 29-36) and 37% (34-41) at 1 year and 21% (18-24) and 22% (19-26) at 5 years, respectively. In multivariate analysis, 4 risk factors had adverse impacts on DFS and OS: (1) age older than 35 years; (2) poor-risk cytogenetics; (3) t-AML not in remission or advanced t-MDS; and (4) donor other than an HLA-identical sibling or a partially or well-matched unrelated donor. Five-year survival for subjects with none, 1, 2, 3, or 4 of these risk factors was 50% (95% CI, 38-61), 26% (20-31), 21% (16-26), 10% (5-15), and 4% (0-16), respectively (P < .001). These data permit a more precise prediction of outcome and identify subjects most likely to benefit from allogeneic transplantation.
治疗相关的骨髓增生异常综合征（t-MDSs）和急性髓系白血病（t-AML）采用常规疗法预后较差。异体移植后报告了令人鼓舞的结果。我们分析了 1990 年至 2004 年期间接受异体移植的 868 名 t-AML（n = 545）或 t-MDS（n = 323）患者的结局。77%的患者采用清髓性预处理方案。1 年时，治疗相关死亡率（TRM）和复发率分别为 41%（95%可信区间[CI]，38-44）和 27%（24-30），5 年时分别为 48%（44-51）和 31%（28-34）。无病生存（DFS）和总生存（OS）分别为 1 年时 32%（95%CI，29-36）和 37%（34-41），5 年时 21%（18-24）和 22%（19-26）。多变量分析显示，4 个危险因素对 DFS 和 OS 有不利影响：（1）年龄大于 35 岁；（2）不良核型；（3）t-AML 未缓解或晚期 t-MDS；（4）供者非 HLA 全相合同胞或部分或全相合无关供者。无、1、2、3、4 个危险因素的患者 5 年生存率分别为 50%（95%CI，38-61）、26%（20-31）、21%（16-26）、10%（5-15）和 4%（0-16）（P<0.001）。这些数据可以更准确地预测结局，并确定最有可能从异体移植中获益的患者。
