含克拉屈滨的预处理方案在 AML/ALL 患者allo-SCT 中的应用:来自 EBMT 急性白血病工作组的一项调查。

Clofarabine-containing conditioning regimen for allo-SCT in AML/ALL patients: a survey from the Acute Leukemia Working Party of EBMT.

机构信息

Centre Hospitalier et Universitaire (CHU) de Nantes, Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie (CI2C), Université de Nantes and INSERM CRNCA UMR, Nantes, France.

出版信息

Eur J Haematol. 2012 Sep;89(3):214-9. doi: 10.1111/j.1600-0609.2012.01822.x. Epub 2012 Aug 9.

Abstract

Clofarabine (CLO), a second-generation purine analogue, has demonstrated an efficient anti-leukemia activity while showing a favorable toxicity profile. This retrospective multicenter report assessed the outcome of 90 patients who received a CLO-containing conditioning regimen before allo-SCT for AML (n = 69) or ALL (n = 21). Median age was 42 yr at transplant. The majority of cases (n = 66) presented with an active disease at transplant while 38 patients had received previous transplantation(s). A total of 88 and two patients received a reduced-intensity conditioning or a myeloablative regimen, respectively. Engraftment was achieved in 97% of evaluable patients. With a median follow-up of 14 months (range, 1-45), the 2-year OS, LFS, relapse, and NRM rates were 28 ± 5%, 23 ± 5%, 41 ± 6%, and 35 ± 5%, respectively. When comparing AML and ALL patients, OS and LFS were significantly higher for AML (OS, 35 ± 6% vs. 0%, P < 0.0001); LFS: 30 ± 6% vs. 0%, P < 0.0001). In a Cox multivariate analysis, an AML diagnosis was the only factor associated with a better LFS (HR = 0.37; 95%CI, 0.21-0.66; P = 0.001). We conclude that a CLO-containing conditioning regimen prior to allo-SCT might be an effective treatment. Prospective studies are needed to evaluate the potential role of CLO as part of conditioning regimens in acute leukemias.

摘要

克拉屈滨(CLO)是一种第二代嘌呤类似物,在具有良好毒性特征的同时表现出高效的抗白血病活性。本回顾性多中心报告评估了 90 例接受含 CLO 预处理方案后进行异基因造血干细胞移植(allo-SCT)的 AML(n = 69)或 ALL(n = 21)患者的结果。移植时中位年龄为 42 岁。大多数病例(n = 66)在移植时处于活跃疾病状态,38 例患者接受了先前的移植。分别有 88 例和 2 例患者接受了强度降低的预处理或清髓性预处理方案。可评估患者中 97%的患者获得了移植物植入。中位随访 14 个月(范围,1-45),2 年 OS、LFS、复发和 NRM 率分别为 28 ± 5%、23 ± 5%、41 ± 6%和 35 ± 5%。在 AML 和 ALL 患者之间比较时,AML 的 OS 和 LFS 明显更高(OS,35 ± 6%比 0%,P < 0.0001;LFS:30 ± 6%比 0%,P < 0.0001)。在 Cox 多变量分析中,AML 诊断是与更好的 LFS 相关的唯一因素(HR = 0.37;95%CI,0.21-0.66;P = 0.001)。我们得出结论,allo-SCT 前含 CLO 的预处理方案可能是一种有效的治疗方法。需要前瞻性研究来评估 CLO 作为急性白血病预处理方案一部分的潜在作用。

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