Princess Margaret Hospital, University of Toronto, Toronto, Ontario.
Blood. 2010 Sep 16;116(11):1839-48. doi: 10.1182/blood-2010-04-278317. Epub 2010 Jun 10.
We compared the outcomes of unrelated donor (URD, n = 358) with human leukocyte antigen (HLA)-matched sibling donor (MSD, n = 226) transplantations in patients with acute myeloid leukemia (AML) in first complete remission (CR1) having unfavorable cytogenetics at diagnosis. Unfavorable cytogenetic abnormalities were: complex (≥ 3 abnormalities), 32%; and noncomplex involving chromosome 7, 25%; chromosome 5, 9%; 11q or MLL rearrangements, 18%; t(6;9), 5%; and other noncomplex, 10%. URDs were HLA-well-matched (n = 254; 71%) or partially-matched (n = 104; 29%). Three-year leukemia-free survival (LFS) for MSD was 42% (95% confidence interval [CI], 35%-48%) compared with 34% (95% CI, 28%-41%) for HLA-well-matched URD and 29% (95% CI, 20%-39%) for partially-matched URD (P = .08). In multivariate analysis, HLA-well-matched URD and MSD yielded similar LFS (relative risk [RR] = 1.1, 95% CI, 0.86-1.40, P = .44) and overall survival (OS; RR = 1.06, 95% CI, 0.83-1.37, P = .63). LFS and OS were significantly inferior for HLA-partially-matched URD recipients, those with prior myelodysplastic syndrome, and those older than 50 years. All cytogenetic cohorts had similar outcomes. Patients with chronic graft-versus-host disease had a significantly lower risk of relapse (RR = 0.68, 95% CI, 0.47-0.99, P = .05). Hematopoietic cell transplantation (HCT) using HLA-well-matched URD and MSD resulted in similar LFS and OS in AML patients in CR1 with unfavorable cytogenetics. Outcomes of HCT from HLA-partially- matched URD were inferior.
我们比较了在初诊时伴有不良细胞遗传学的急性髓系白血病（AML）患者中，无关供体（URD，n = 358）与人类白细胞抗原（HLA）匹配的同胞供体（MSD，n = 226）移植的结果。不良细胞遗传学异常包括：复杂（≥ 3 种异常），32%；非复杂涉及染色体 7，25%；染色体 5，9%；11q 或 MLL 重排，18%；t（6；9），5%；以及其他非复杂，10%。URD 为 HLA 高度匹配（n = 254；71%）或部分匹配（n = 104；29%）。MSD 的 3 年无白血病生存率（LFS）为 42%（95%置信区间[CI]，35%-48%），而 HLA 高度匹配 URD 为 34%（95% CI，28%-41%），部分匹配 URD 为 29%（95% CI，20%-39%）（P =.08）。多变量分析显示，HLA 高度匹配 URD 和 MSD 的 LFS 相似（相对风险[RR] = 1.1，95% CI，0.86-1.40，P =.44）和总生存（OS；RR = 1.06，95% CI，0.83-1.37，P =.63）。HLA 部分匹配 URD 受体、有先前骨髓增生异常综合征和年龄大于 50 岁的患者的 LFS 和 OS 显著降低。所有细胞遗传学队列的结果相似。患有慢性移植物抗宿主病的患者复发风险显著降低（RR = 0.68，95% CI，0.47-0.99，P =.05）。使用 HLA 高度匹配 URD 和 MSD 的造血细胞移植（HCT）在伴有不良细胞遗传学的 CR1 期 AML 患者中产生了相似的 LFS 和 OS。HLA 部分匹配 URD 的 HCT 结果较差。
