Song A-Xia, Yang Dong-Lin, Wei Jia-Lin, Yan Zhang-Song, Wang Mei, Jiang Er-Lie, Huang Yong, Liu Qing-Guo, Ma Qiao-Ling, Zhai Wei-Hua, Zhang Rong-Li, Feng Si-Zhou, Han Ming-Zhe
Institute of Hematology & Hospital of Blood Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China.
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2010 Feb;18(1):161-6.
This study was purposed to evaluate the outcome of patients with acute myeloid leukemia (AML) who received allogeneic hematopoietic stem cell transplantation (allo-HSCT) in complete remission, and to study the prognostic factors. 75 cases of AML in complete remission receiving allo-HSCT from January 2000 to December 2007 were retrospectively analyzed. Major end points of study included overall survival (OS), disease free survival (DFS), relapse rate and transplantation related mortality (TRM). The results showed that 3-year OS and DFS of the study population reached to 58.4% and 53.9% respectively, and the relapse rate and TRM leaded to 16.9% and 29.9% respectively. Incidence of acute GVHD was 59.6%, with 18.7% II-IV aGVHD. Different prognosis was observed between HSCT recipients of alternative donor and HLA-matched related donor (MRD) (3-year DFS was 34.3% vs 60.0%, p = 0.019), between patients of refractory leukemia and the control (3-year DFS was 35.7% vs 58.2%, p = 0.048), between recipients with and without severe aGVHD (3-year DFS was 35.7% vs 54.4%, p = 0.059). Further analysis revealed significantly high TRM in recipients receiving allo-HSCT of alternative donor (p = 0.033) and high rate of severe aGVHD (p = 0.010). Multivariate analysis revealed three negative prognostic factors: donor availability (alternative vs MRD) (p = 0.049, RR = 2.09, 95%CI 1.01 - 4.36), refractory leukemia (p = 0.038, RR = 2.33, 95%CI 1.05 - 5.20) and severe aGVHD (p = 0.040, RR = 2.33, 95%CI 1.04 - 5.20). It is concluded that allo-HSCT is a choice for the AML case at complete remission and TRM is the major cause of the transplantation failure. Donor availability, refractory leukemia and severe aGVHD are confirmed as risk factors of poor prognosis for allo-HSCT patients with AML in CR.
本研究旨在评估急性髓系白血病（AML）患者在完全缓解后接受异基因造血干细胞移植（allo-HSCT）的疗效，并研究预后因素。回顾性分析了2000年1月至2007年12月期间75例接受allo-HSCT的完全缓解AML患者。研究的主要终点包括总生存期（OS）、无病生存期（DFS）、复发率和移植相关死亡率（TRM）。结果显示，研究人群的3年OS和DFS分别达到58.4%和53.9%，复发率和TRM分别为16.9%和29.9%。急性移植物抗宿主病（GVHD）的发生率为59.6%，其中II-IV级急性GVHD为18.7%。替代供体与人类白细胞抗原（HLA）匹配的相关供体（MRD）的HSCT受者之间观察到不同的预后（3年DFS为34.3%对60.0%，p = 0.019），难治性白血病患者与对照组之间（3年DFS为35.7%对58.2%，p = 0.048），有和无严重急性GVHD的受者之间（3年DFS为35.7%对54.4%，p = 0.059）。进一步分析显示，接受替代供体allo-HSCT的受者TRM显著较高（p = 0.033），严重急性GVHD发生率较高（p = 0.010）。多因素分析显示三个不良预后因素：供体可及性（替代供体与MRD）（p = 0.049，RR = 2.09，95%CI 1.01 - 4.36）、难治性白血病（p = 0.038，RR = 2.33，95%CI 1.05 - 5.20）和严重急性GVHD（p = 0.040，RR = 2.33，95%CI 1.04 - 5.20）。结论是，allo-HSCT是完全缓解AML病例的一种选择，TRM是移植失败的主要原因。供体可及性、难治性白血病和严重急性GVHD被确认为CR期AML患者allo-HSCT预后不良的危险因素。
