Division of Hematology-Bone Marrow Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Leuk Lymphoma. 2012 Jan;53(1):96-102. doi: 10.3109/10428194.2011.603445. Epub 2011 Aug 24.
Patients with therapy-related acute myeloid leukemia (t-AML) and myelodysplastic syndromes (t-MDS) have poor survival and high non-relapse mortality (NRM) after allogeneic stem cell transplantation. This retrospective study assessed the transplant outcomes of 29 consecutive patients with t-AML (83%) or t-MDS (17%) treated with allogeneic transplantation. The median age of patients was 51 years. Donors were mostly matched unrelated (52%), and 59% of patients received myeloablative conditioning. Two-year overall survival, event-free survival and relapse incidence were 37%, 34% and 33%; NRM was 17% at 100 days, and 32% at 2 years. Event-free survival was reduced in patients with high-risk cytogenetics (p = 0.02), Karnofsky performance status ≤ 80% (p = 0.001) and disease after induction ± consolidation (p = 0.006). NRM was higher in patients receiving > 2 therapy lines for previous cancer (p = 0.01) and in those allografted > 6 months from diagnosis (p = 0.03). In conclusion, allogeneic transplantation should be proposed timely to these patients after an accurate analysis of patient history.
伴治疗相关性急性髓系白血病（t-AML）和骨髓增生异常综合征（t-MDS）的患者在接受异基因造血干细胞移植后生存状况较差且非复发死亡率（NRM）较高。本回顾性研究评估了 29 例伴 t-AML（83%）或 t-MDS（17%）接受异基因移植治疗患者的移植结局。患者的中位年龄为 51 岁。供者多为匹配的无关供者（52%），59%的患者接受了清髓性预处理。2 年总生存率、无事件生存率和复发率分别为 37%、34%和 33%；100 天时 NRM 为 17%，2 年时 NRM 为 32%。具有高危细胞遗传学（p=0.02）、Karnofsky 表现状态≤80%（p=0.001）和诱导后±巩固治疗后疾病（p=0.006）的患者无事件生存率降低。既往癌症接受>2 线治疗（p=0.01）和从诊断起>6 个月接受移植（p=0.03）的患者 NRM 更高。总之，应对这些患者进行准确的病史分析后，及时提出异基因移植建议。
