Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA 98195-6043, USA.
Int J Radiat Oncol Biol Phys. 2011 May 1;80(1):193-8. doi: 10.1016/j.ijrobp.2010.01.062. Epub 2010 Jun 30.
Neither the prognostic importance nor the appropriate management of central nervous system (CNS) involvement is known for patients with acute myeloid leukemia (AML) undergoing hematopoietic cell transplantation (HCT). We examined the impact of a CNS irradiation boost to standard intrathecal chemotherapy (ITC).
From 1995 to 2005, a total of 648 adult AML patients received a myeloablative HCT: 577 patients were CNS negative (CNS-), and 71 were CNS positive (CNS+). Of the 71 CNS+ patients, 52 received intrathecal chemotherapy alone (CNS+ITC), and 19 received ITC plus an irradiation boost (CNS+RT).
The CNS-, CNS+ITC, and CNS+RT patients had 1- and 5-year relapse-free survivals (RFS) of 43% and 35%, 15% and 6%, and 37% and 32%, respectively. CNS+ITC patients had a statistically significant worse RFS compared with CNS- patients (hazard ratio [HR], 2.65; 95% confidence interval [CI], 2.0-3.6; p < 0.0001). CNS+RT patients had improved relapse free survival over that of CNS+ITC patients (HR, 0.45; 95% CI, 0.2-0.8; p = 0.01). The 1- and 5-year overall survivals (OS) of patients with CNS-, CNS+ITC, and CNS+RT, were 50% and 38%, 21% and 6%, and 53% and 42%, respectively. The survival of CNS+RT were significantly better than CNS+ITC patients (p = 0.004). After adjusting for known risk factors, CNS+RT patients had a trend toward lower relapse rates and reduced nonrelapse mortality.
CNS+ AML is associated with a poor prognosis. The role of a cranial irradiation boost to intrathecal chemotherapy appears to mitigate the risk of CNS disease, and needs to be further investigated to define optimal treatment strategies.
对于接受造血细胞移植（HCT）的急性髓细胞白血病（AML）患者，中枢神经系统（CNS）受累的预后意义和适当的治疗方法尚不清楚。我们研究了 CNS 照射对标准鞘内化疗（ITC）的影响。
1995 年至 2005 年，共有 648 例成人 AML 患者接受了清髓性 HCT：577 例患者 CNS 阴性（CNS-），71 例患者 CNS 阳性（CNS+）。在 71 例 CNS+患者中，52 例接受单纯鞘内化疗（CNS+ITC），19 例接受 ITC 加照射增敏（CNS+RT）。
CNS-、CNS+ITC 和 CNS+RT 患者的 1 年和 5 年无复发生存率（RFS）分别为 43%和 35%、15%和 6%、37%和 32%。与 CNS-患者相比，CNS+ITC 患者的 RFS 明显更差（风险比[HR]，2.65；95%置信区间[CI]，2.0-3.6；p < 0.0001）。与 CNS+ITC 患者相比，CNS+RT 患者的无复发生存率有所改善（HR，0.45；95%CI，0.2-0.8；p = 0.01）。CNS-、CNS+ITC 和 CNS+RT 患者的 1 年和 5 年总生存率（OS）分别为 50%和 38%、21%和 6%、53%和 42%。CNS+RT 患者的生存情况明显优于 CNS+ITC 患者（p = 0.004）。在调整了已知的危险因素后，CNS+RT 患者的复发率有降低的趋势，非复发死亡率也有所降低。
CNS+AML 预后不良。CNS 照射对 ITC 的作用似乎可以降低 CNS 疾病的风险，需要进一步研究以确定最佳治疗策略。
