Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Blood. 2011 Aug 11;118(6):1490-4. doi: 10.1182/blood-2011-02-339721. Epub 2011 Jun 16.
Monosomal karyotype (MK), defined as ≥ 2 autosomal monosomies or a single monosomy in the presence of other structural abnormalities, was confirmed by several studies to convey an extremely poor prognosis in patients with acute myeloid leukemia (AML) with a 4-year overall survival after diagnosis of < 4%. A recent investigation by the Southwest Oncology Group found that the only MK(+) patients alive and disease free > 6 years from diagnosis received allogeneic hematopoietic cell transplantation (HCT). To expand this observation, we retrospectively analyzed 432 patients treated with HCT at the Fred Hutchinson Cancer Research Center, 14% of whom were MK(+). The 4-year overall survival of patients after HCT was 25% for MK(+) AML and 56% for MK(-) AML (adjusted hazard ratio = 2.29, P < .0001). Among the MK(+) patients, complex karyotype was associated with a significantly worse outcome than patients with noncomplex karyotype (adjusted hazard ratio = 2.70, P = .03). Thus, although the prognosis of MK(+) patients remains worse than that for MK(-) patients in the transplantation setting, HCT appears to improve the overall outcome of MK(+) patients, especially patients without a complex karyotype. However, the 28% of MK(+) patients > 60 years had only a 6% 4-year survival rate after HCT, stressing the need for new approaches in these patients.
单体型核型（MK）定义为≥2 条常染色体单体缺失或在存在其他结构异常的情况下存在一条单体缺失，多项研究证实，患有急性髓细胞白血病（AML）的患者具有非常差的预后，诊断后 4 年的总生存率<4%。最近，西南肿瘤协作组的一项调查发现，唯一在诊断后 6 年以上无病生存且存活的 MK(+)患者接受了异基因造血细胞移植（HCT）。为了扩展这一观察结果，我们回顾性分析了在弗雷德·哈钦森癌症研究中心接受 HCT 治疗的 432 名患者，其中 14%为 MK(+)。HCT 后患者的 4 年总生存率为 MK(+)AML 为 25%，MK(-)AML 为 56%（调整后的危险比=2.29，P<.0001）。在 MK(+)患者中，复杂核型与非复杂核型患者的预后显著更差（调整后的危险比=2.70，P=.03）。因此，尽管在移植环境中 MK(+)患者的预后仍然比 MK(-)患者差，但 HCT 似乎改善了 MK(+)患者的总体预后，尤其是无复杂核型的患者。然而，28%的>60 岁的 MK(+)患者在 HCT 后仅 6%的 4 年生存率，这强调了这些患者需要新的治疗方法。
