Zhou Qian-Lan, Tang Xiao-Wen, Sun Ai-Ning, Qiu Hui-Ying, Jin Zheng-Ming, Miao Miao, Fu Zheng-Zheng, Zhao Bing-Rui, Shi Xiao-Lan, Chen Guang-Hua, Wu De-Pei
Department of Hematology, the First Affiliated Hospital of Soochow University, Jiangsu Province, China.
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2012 Aug;20(4):954-8.
The study was aimed to evaluate the impact of disease status on the outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with refractory and relapsed acute myeloid leukemia (AML). 32 patients with refractory and relapsed AML received allo-HSCT after myeloablative conditioning regimen, including 17 patients in no-remission (NR) and 15 patients in complete remission (CR) at the time of transplant. Treatment related adverse events, relapse rate and leukemia free survival (LFS) were analyzed. The results showed that the parameters of sex, age, cytogenetic risk and transplant procedures were comparable between the two groups. 30 patients had successful engraftment, except one had graft failure and one died from severe veno-occlusive disease in the NR group. The incidences of aGVHD in NR group and CR group were 47.1% (8 patients) and 33.5% (5 patients) respectively. Out of comparable patients, 5 from 9 patients in NR group developed with cGVHD, and 4 from 11 patients in CR group were subjected to cGVHD. There were no statistic difference in incidences of aGVHD and cGVHD between two group. Compa-red with CR group, NR group had a higher treatment-related mortality (29.4% vs 14.3%, P = 0.392) and relapse rate (42.9% vs 26.7% P = 0.300), but there was no significant difference. With a median follow-up of 13 (1 - 124) months, 6 patients remained alive in both of the two groups, and the 2 year LFS of them were parallel (35.3% vs 40.0%, P = 0.267). Among these 32 patients, overall survival (OS) was better in patients with age < 35 years (P = 0.044) and with the appearance of cGVHD (P = 0.046). It is concluded that allo-HSCT is an effective salvage therapy for patients with refractory and relapsed AML, and the overall outcome seems unrelated to the disease status (NR or CR) before transplantation. As such, for refractory and relapsed AML patients in non-remission, performance of allo-HSCT to achieve long-term survival is feasible.
本研究旨在评估疾病状态对难治性和复发性急性髓系白血病（AML）患者异基因造血干细胞移植（allo-HSCT）结局的影响。32例难治性和复发性AML患者在接受清髓性预处理方案后接受了allo-HSCT，其中17例患者在移植时处于未缓解（NR）状态，15例患者处于完全缓解（CR）状态。分析了治疗相关不良事件、复发率和无白血病生存期（LFS）。结果显示，两组患者的性别、年龄、细胞遗传学风险和移植程序等参数具有可比性。30例患者成功植入，NR组有1例发生移植失败，1例死于严重的肝静脉闭塞病。NR组和CR组急性移植物抗宿主病（aGVHD）的发生率分别为47.1%（8例）和33.5%（5例）。在具有可比性的患者中，NR组9例中有5例发生慢性移植物抗宿主病（cGVHD），CR组11例中有4例发生cGVHD。两组之间aGVHD和cGVHD的发生率无统计学差异。与CR组相比，NR组的治疗相关死亡率（29.4%对14.3%，P = 0.392）和复发率（42.9%对26.7%，P = 0.300）更高，但无显著差异。中位随访13（1 - 124）个月时，两组均有6例患者存活，其2年LFS相似（35.3%对40.0%，P = 0.267）。在这32例患者中，年龄<35岁的患者总体生存期（OS）较好（P = 0.044），出现cGVHD的患者OS也较好（P = 0.046）。结论是，allo-HSCT是难治性和复发性AML患者有效的挽救性治疗方法，总体结局似乎与移植前的疾病状态（NR或CR）无关。因此，对于未缓解的难治性和复发性AML患者，进行allo-HSCT以实现长期生存是可行的。
