Princess Margaret Hospital, University of Toronto, Ontario, Canada.
Haematologica. 2013 Feb;98(2):185-92. doi: 10.3324/haematol.2012.062059. Epub 2012 Sep 14.
The optimal post-remission treatment for acute myeloid leukemia in first complete remission remains uncertain. Previous comparisons of autologous versus allogeneic hematopoietic cell transplantation noted higher relapse, but lower treatment-related mortality though using bone marrow grafts, with treatment-related mortality of 12-20%. Recognizing lower treatment-related mortality using autologous peripheral blood grafts, in an analysis of registry data from the Center for International Blood and Transplant Research, we compared treatment-related mortality, relapse, leukemia-free survival, and overall survival for patients with acute myeloid leukemia in first complete remission (median ages 36-44, range 19-60) receiving myeloablative HLA-matched sibling donor grafts (bone marrow, n=475 or peripheral blood, n=428) versus autologous peripheral blood (n=230). The 5-year cumulative incidence of treatment-related mortality was 19% (95% confidence interval, 16-23%), 20% (17-24%) and 8% (5-12%) for allogeneic bone marrow, allogeneic peripheral blood and autologous peripheral blood stem cell transplant recipients, respectively. The corresponding figures for 5-year cumulative incidence of relapse were 20% (17-24%), 26% (21-30%) and 45% (38-52%), respectively. At 5 years, leukemia-free survival and overall survival rates were similar: allogeneic bone marrow 61% (56-65%) and 64% (59-68%); allogeneic peripheral blood 54% (49-59%) and 59% (54-64%); autologous peripheral blood 47% (40-54%) and 54% (47-60%); P=0.13 and P=0.19, respectively. In multivariate analysis the incidence of treatment-related mortality was lower after autologous peripheral blood transplantation than after allogeneic bone marrow/peripheral blood transplants [relative risk 0.37 (0.20-0.69); P=0.001], but treatment failure (death or relapse) after autologous peripheral blood was significantly more likely [relative risk 1.32 (1.06-1.64); P=0.011]. The 5-year overall survival, however, was similar in patients who received autologous peripheral blood (n=230) [relative risk 1.23 (0.98-1.55); P=0.071] or allogeneic bone marrow/peripheral blood (n=903). In the absence of an HLA-matched sibling donor, autologous peripheral blood may provide acceptable alternative post-remission therapy for patients with acute myeloid leukemia in first complete remission.
急性髓系白血病首次完全缓解后的最佳缓解后治疗仍不确定。先前对自体与异基因造血细胞移植的比较指出，复发率较高，但使用骨髓移植物的治疗相关死亡率较低，为 12-20%。认识到使用自体外周血移植物的治疗相关死亡率较低，在国际血液和移植研究中心的注册数据分析中，我们比较了急性髓系白血病首次完全缓解患者的治疗相关死亡率、复发、无白血病生存率和总生存率（中位数年龄 36-44 岁，范围 19-60 岁）接受清髓性 HLA 匹配同胞供体移植物（骨髓，n=475 或外周血，n=428）与自体外周血（n=230）。异体骨髓、异体外周血和自体外周血干细胞移植受者的 5 年累积治疗相关死亡率分别为 19%（95%置信区间，16-23%）、20%（17-24%）和 8%（5-12%）。相应的 5 年累积复发率分别为 20%（17-24%）、26%（21-30%）和 45%（38-52%）。5 年时，无白血病生存率和总生存率相似：异体骨髓 61%（56-65%）和 64%（59-68%）；异体外周血 54%（49-59%）和 59%（54-64%）；自体外周血 47%（40-54%）和 54%（47-60%）；P=0.13 和 P=0.19，分别。多变量分析显示，自体外周血移植后治疗相关死亡率低于异体骨髓/外周血移植[相对风险 0.37（0.20-0.69）；P=0.001]，但自体外周血治疗失败（死亡或复发）的可能性显著增加[相对风险 1.32（1.06-1.64）；P=0.011]。然而，接受自体外周血（n=230）或异体骨髓/外周血（n=903）的患者 5 年总生存率相似。在没有 HLA 匹配的同胞供体的情况下，自体外周血可能为急性髓系白血病首次完全缓解患者提供可接受的缓解后替代治疗。
