Department of Stem Cell Transplantation and Cellular Therapy, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
Biol Blood Marrow Transplant. 2013 Feb;19(2):214-20. doi: 10.1016/j.bbmt.2012.09.002. Epub 2012 Sep 13.
Risk stratification is important to identify patients with acute myelogenous leukemia (AML) who might benefit from allogeneic hematopoietic stem cell transplantation (allo-HSCT) in first complete remission. We retrospectively studied 150 patients with AML and diagnostic cytogenetic abnormalities who underwent myeloablative allo-HSCT while in first complete remission to evaluate the prognostic impact of persistent cytogenetic abnormalities at allo-HSCT. Three risk groups were identified. Patients with favorable/intermediate cytogenetics at diagnosis (n = 49) and patients with unfavorable cytogenetics at diagnosis but without a persistent abnormal clone at allo-HSCT (n = 83) had a similar 3-year leukemia-free survival of 58%-60% despite the higher 3-year relapse incidence (RI) in the latter group (32.3%, versus 16.8% in the former group). A third group of patients with unfavorable cytogenetics at diagnosis and a persistent abnormal clone at allo-HSCT (n = 15) had the worst prognosis, with a 3-year RI of 57.5% and 3-year leukemia-free survival of only 29.2%. These data suggest that patients with AML and unfavorable cytogenetics at diagnosis and a persistent abnormal clone at allo-HSCT are at high risk for relapse after allo-HSCT. These patients should be considered for clinical trials designed to optimize conditioning regimens and/or to use preemptive strategies in the posttransplantion setting aimed at decreasing RI.
风险分层对于识别处于首次完全缓解期的急性髓系白血病（AML）患者非常重要，这些患者可能从异基因造血干细胞移植（allo-HSCT）中获益。我们回顾性研究了 150 例在首次完全缓解期接受清髓性 allo-HSCT 的伴有诊断性细胞遗传学异常的 AML 患者，以评估 allo-HSCT 时持续性细胞遗传学异常对预后的影响。我们确定了 3 个风险组。在诊断时具有良好/中等细胞遗传学（n=49）和在诊断时具有不良细胞遗传学但在 allo-HSCT 时无持续性异常克隆的患者（n=83）尽管后者的 3 年复发率（RI）较高（32.3%，而前者为 16.8%），但 3 年无白血病生存率相似（58%-60%）。第三组在诊断时具有不良细胞遗传学且在 allo-HSCT 时具有持续性异常克隆的患者（n=15）预后最差，3 年 RI 为 57.5%，3 年无白血病生存率仅为 29.2%。这些数据表明，在诊断时具有不良细胞遗传学且在 allo-HSCT 时具有持续性异常克隆的 AML 患者在 allo-HSCT 后复发的风险较高。这些患者应考虑参加临床试验，旨在优化预处理方案，和/或在移植后使用抢先策略，以降低 RI。
