Division of Hematology, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan.
Int J Hematol. 2010 Mar;91(2):284-92. doi: 10.1007/s12185-009-0483-2.
We prospectively compared allogeneic hematopoietic stem cell transplantation (allo-HSCT) with chemotherapy as a post-remission therapy in a multicenter trial (JALSG AML97) of adult patients with intermediate or poor risk acute myeloid leukemia (AML). Of 503 patients aged 15-50 years old registered between December 1997 and July 2001, 392 achieved complete remission (CR). CR patients classified in the intermediate or poor risk group using a new scoring system were tissue typed. Seventy-three with and 92 without an HLA-identical sibling were assigned to the donor and no-donor groups. Of 73 patients in the donor group, 38 (52%) received allo-HSCT during CR1 and 17 (23%) after relapse. Intention-to-treat analysis revealed that the relapse incidence was reduced in the donor group (52 vs. 77%; p = 0.008), and the disease-free survival (DFS) improved (39 vs. 19%; p = 0.016), but overall survival (OS) was not significantly different (46 vs. 29%; p = 0.088). The OS benefit was seen in the patients aged 36-50 years old (49 vs. 24%; p = 0.031), suggesting an advantage of allo-HSCT among older patients with leukemia that is more resistant to chemotherapy than that among younger patients.
我们前瞻性地比较了同种异体造血干细胞移植（allo-HSCT）与化疗作为缓解后治疗在一项多中心试验（JALSG AML97）中的作用，该试验纳入了年龄在 15-50 岁的中危或高危成人急性髓细胞白血病（AML）患者。在 1997 年 12 月至 2001 年 7 月期间登记的 503 例患者中，有 392 例达到完全缓解（CR）。使用新的评分系统对 CR 患者进行分类，确定为中危或高危的患者进行组织配型。其中 73 例有 HLA 相合同胞供者，92 例无 HLA 相合同胞供者，分别归入供者组和无供者组。在供者组的 73 例患者中，有 38 例（52%）在 CR1 期间接受 allo-HSCT，17 例（23%）在复发后接受 allo-HSCT。意向治疗分析显示，供者组的复发率降低（52%比 77%；p = 0.008），无病生存（DFS）改善（39%比 19%；p = 0.016），但总生存（OS）无显著差异（46%比 29%；p = 0.088）。OS 获益见于年龄在 36-50 岁的患者（49%比 24%；p = 0.031），提示allo-HSCT 对化疗耐药性更高的老年白血病患者有优势，而对年轻患者则没有优势。
