Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan;
Blood. 2011 Feb 17;117(7):2113-20. doi: 10.1182/blood-2010-05-285502. Epub 2010 Nov 24.
Various prospective trials have been performed to assess the roles of allogeneic hematopoietic cell transplantation (allo-HCT) and chemotherapy in patients with acute myeloid leukemia (AML) in first complete remission (CR1). However, the results have not always been consistent, and there has been a limited evaluation of quality of life (QOL) in these postremission strategies. We performed a Markov decision analysis that enabled us to compare survival outcomes with a QOL evaluation using a database of 2029 adult AML patients who achieved CR1. The Markov decision model compared 2 strategies: allo-HCT or chemotherapy in CR1. Patients who had intermediate- or unfavorable-risk AML had a longer life expectancy when they received allo-HCT in CR1 than patients treated with chemotherapy alone. Likewise, patients who had a suitable related donor who received allo-HCT in CR1 had a longer life expectancy. The life expectancy was shortened to a greater degree by adjustment for QOL in the allo-HCT group. Nevertheless, QOL-adjusted life expectancies in most of the subgroups remained longer in the allo-HCT group than in the chemotherapy group. Our results showed that older patients with a related donor and younger patients with unfavorable cytogenetics benefited the most from allo-HCT in CR1.
已经进行了各种前瞻性试验，以评估异基因造血细胞移植（allo-HCT）和化疗在首次完全缓解（CR1）的急性髓系白血病（AML）患者中的作用。然而，结果并不总是一致的，并且这些缓解后策略的生活质量（QOL）评估也很有限。我们进行了一项马尔可夫决策分析，使我们能够使用数据库中的 2029 例达到 CR1 的成年 AML 患者的生存结果和 QOL 评估进行比较。马尔可夫决策模型比较了两种策略：CR1 中的 allo-HCT 或化疗。患有中危或高危 AML 的患者在 CR1 中接受 allo-HCT 比单独接受化疗的患者具有更长的预期寿命。同样，在 CR1 中接受 allo-HCT 且有合适的相关供体的患者也具有更长的预期寿命。在 allo-HCT 组中，通过 QOL 调整，预期寿命缩短的程度更大。尽管如此，在 allo-HCT 组中，大多数亚组的 QOL 调整后的预期寿命仍然长于化疗组。我们的结果表明，年龄较大的有相关供体的患者和年龄较小的细胞遗传学不良的患者从 CR1 中的 allo-HCT 中获益最多。
