Pusan National University Medical School, Pusan National University Hospital, Busan, Korea.
Jpn J Clin Oncol. 2010 Jun;40(6):556-66. doi: 10.1093/jjco/hyq007. Epub 2010 Feb 25.
The purpose of this study was to re-evaluate post-remission therapy outcomes after first remission according to years of patient enrollment in patients with core binding factor acute myeloid leukaemia.
We conducted a retrospective study on 138 patients aged less than 60 years diagnosed with core binding factor acute myeloid leukaemia between 1994 and 2006, comparing allogeneic stem cell transplantation and high-dose cytarabine chemotherapy as post-remission treatment options after the first remission.
The 5-year probabilities of disease-free survival and overall survival were not different between allogeneic stem cell transplantation and high-dose cytarabine groups. However, 3-year probabilities of disease-free survival (86.7% vs. 67.0%) and overall survival (90.0% vs. 67.3%) showed a trend towards improvement in the allogeneic stem cell transplantation group compared with the high-dose cytarabine group in cohort after 2003 (2003-2006), whereas outcomes were not different in cohort before 2003 (1994-2002). Especially, 3-year probabilities of disease-free survival (95.2% vs. 59.3%, P = 0.008) and overall survival (95.2% vs. 59.6%, P = 0.032) of allogeneic stem cell transplantation group were significantly better than high-dose cytarabine group in cohort after 2003 of acute myeloid leukaemia patients with t(8;21). The relative risk of overall survival with allogeneic stem cell transplantation, compared with high-dose cytarabine chemotherapy, was significantly improved in the cohort after 2003 (0.33; 95% CI, 0.07-1.48) when compared with that before 2003 (1.92; 95% CI, 0.77-4.82). In multivariate analysis in cohort after 2003, allogeneic stem cell transplantation as post-remission therapy was associated with better disease-free survival.
Allogeneic stem cell transplantation is currently the more effective post-remission therapy than it was prior to 2003 for core binding factor acute myeloid leukaemia achieving first remission. On the contrary to previous findings, allogeneic stem cell transplantation provides significantly improved outcomes than high-dose cytarabine chemotherapy in acute myeloid leukaemia with t(8;21).
本研究旨在根据患者入组年限，重新评估初缓解后巩固治疗的缓解后治疗结局。
我们对 1994 年至 2006 年间诊断为核心结合因子急性髓系白血病的 138 例年龄小于 60 岁的患者进行了回顾性研究，比较了异基因造血干细胞移植和高剂量阿糖胞苷化疗作为首次缓解后的缓解后治疗选择。
异基因造血干细胞移植组和高剂量阿糖胞苷组的无病生存和总生存 5 年概率无差异。然而，在 2003 年后的队列中（2003-2006 年），异基因造血干细胞移植组的 3 年无病生存（86.7% vs. 67.0%）和总生存（90.0% vs. 67.3%）概率均高于高剂量阿糖胞苷组，而在 2003 年前的队列中（1994-2002 年），两组无差异。特别是在 2003 年后的队列中，急性髓系白血病伴 t(8;21)的患者中，异基因造血干细胞移植组的 3 年无病生存（95.2% vs. 59.3%，P=0.008）和总生存（95.2% vs. 59.6%，P=0.032）概率显著优于高剂量阿糖胞苷组。与高剂量阿糖胞苷化疗相比，2003 年后队列中异基因造血干细胞移植的总生存相对风险显著提高（0.33；95%CI，0.07-1.48），而 2003 年前队列中（1.92；95%CI，0.77-4.82）无差异。在 2003 年后的队列中进行的多变量分析中，异基因造血干细胞移植作为缓解后治疗与更好的无病生存相关。
对于初缓解的核心结合因子急性髓系白血病患者，与 2003 年前相比，异基因造血干细胞移植目前是更有效的缓解后治疗方法。与之前的研究结果相反，异基因造血干细胞移植在伴有 t(8;21)的急性髓系白血病患者中提供了显著优于高剂量阿糖胞苷化疗的生存获益。
