Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
Biol Blood Marrow Transplant. 2010 Jul;16(7):957-66. doi: 10.1016/j.bbmt.2010.02.003. Epub 2010 Feb 7.
Adults with high-risk acute lymphoblastic leukemia (HR-ALL) have a poor outcome with standard chemotherapy and usually undergo unrelated stem cell transplantation (SCT) if a matched sibling donor is not available. We analyzed the outcome of adult patients with unrelated SCT for HR-ALL and studied the possible effect of the hematopoietic stem cell source of the transplant. A total of 149 adult patients (median age, 29 years, range, 15-59 years) with HR-ALL underwent unrelated SCT in 13 Spanish institutions between 2000 and 2007. Patients in first complete remission (CR1) at transplantation had at least one adverse prognostic factor (advanced age, adverse cytogenetics, hyperleukocytosis, or slow response to induction therapy). ALL was in CR1 in 81 patients (54%), in second CR (CR2) in 37 patients (25%), in third CR (CR3) in 11 patients (7%), and with overt disease in 20 patients (13%). The hematopoietic source was unrelated cord blood (UCB) in 62 patients and an unrelated donor (UD) in 87 patients. The patients undergoing UCB-SCT and UD-SCT were comparable in terms of the main clinical and biological features of ALL, except for a higher frequency of patients with more overt disease in the UCB-SCT group. There was no statistically significant difference in overall survival (OS) or disease-free survival (DFS) at 5 years between the 2 groups. Treatment-related mortality (TRM) was significantly lower in the UCB-SCT group (P = .021). The probability of relapse at 1 year was 17% (95% confidence interval [CI], 7%-27%) for the UD-SCT group and 27% (95% CI, 14%-40%) for the UCB-SCT group (P = .088), respectively. Only disease status at transplantation (CR1, 41% [95% CI, 18%-64%] vs CR2, 51% [95% CI, 17%-85%] vs advanced disease, 66% [95% CI, 46%-86%]; P = .001) and the absence of chronic graft-versus-host disease (74% [95% CI, 46%-100%] vs 33% [95% CI, 17%-49%]; P = .034) were significant factors for relapse. All unrelated transplantation modalities were associated with high treatment-related mortality for adult HR-ALL patients without a sibling donor. UCB-SCT and UD-SCT were found to be equivalent options. Disease status at transplantation and chronic GVHD were the main factors influencing relapse in both transplantation modalities.
成人高危急性淋巴细胞白血病（HR-ALL）患者采用标准化疗的预后较差，如果没有匹配的同胞供体，则通常需要进行无关供体干细胞移植（SCT）。我们分析了 13 家西班牙机构在 2000 年至 2007 年间进行的无关供体 SCT 治疗成人 HR-ALL 患者的结果，并研究了移植中造血干细胞来源的可能影响。共有 149 名 HR-ALL 成人患者（中位年龄 29 岁，范围 15-59 岁）在 13 个西班牙机构接受了无关供体 SCT。移植时处于完全缓解 1 期（CR1）的患者至少存在一个不良预后因素（年龄较大、不良细胞遗传学、白细胞增多或诱导治疗反应缓慢）。81 名患者（54%）处于完全缓解 1 期（CR1），37 名患者（25%）处于完全缓解 2 期（CR2），11 名患者（7%）处于完全缓解 3 期（CR3），20 名患者（13%）处于明显疾病状态。造血来源为无关脐带血（UCB）的有 62 名患者，无关供体（UD）的有 87 名患者。UCB-SCT 和 UD-SCT 组患者在 ALL 的主要临床和生物学特征方面相当，除了 UCB-SCT 组中更明显疾病状态的患者比例较高。两组患者的总生存率（OS）或无病生存率（DFS）在 5 年时无统计学差异。UCB-SCT 组的治疗相关死亡率（TRM）明显较低（P=.021）。UCB-SCT 组 1 年时的复发率为 17%（95%置信区间 [CI]，7%-27%），而 UD-SCT 组为 27%（95% CI，14%-40%）（P=.088）。仅移植时的疾病状态（CR1，41%[95%CI，18%-64%] vs CR2，51%[95%CI，17%-85%] vs 进展期疾病，66%[95%CI，46%-86%]；P=.001）和无慢性移植物抗宿主病（74%[95%CI，46%-100%] vs 33%[95%CI，17%-49%]；P=.034）是复发的显著因素。对于没有同胞供体的成人高危 ALL 患者，所有无关供体移植方式均与较高的治疗相关死亡率相关。UCB-SCT 和 UD-SCT 被认为是等效的选择。移植时的疾病状态和慢性移植物抗宿主病是两种移植方式影响复发的主要因素。
