Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou Dadao North Street no. 1838, Guangzhou, Guangdong, China.
Ann Hematol. 2013 May;92(5):679-87. doi: 10.1007/s00277-012-1662-4. Epub 2012 Dec 30.
Knowledge concerning the clinical and biological characteristics of acute leukemia of ambiguous lineage (ALAL) is limited so that there has been a lack of uniformity in treatment. In this report, we retrospectively investigated the effect of intensified conditioning on adult ALAL undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). A total of 59 patients with ALAL (male in 37 cases and female in 22 cases) were consecutively enrolled in the data analyses. Twenty-four patients received the standard conditioning (total body irradiation (TBI) + cyclophosphamide (CY) or busulfan + CY protocol) and 35 received the intensified conditioning (TBI + CY + etoposide or fludarabine + cytarabine plus TBI + CY + etoposide protocol). Five-year transplant-related mortality was 17.6 ± 9.6 % and 25.5 ± 8.0 %, the 5-year overall survival (OS) post-transplantation was 23.8 ± 8.9 % and 64.0 ± 8.4 %, disease-free survival was 16.7 ± 7.6 % and 55.8 ± 9.4 %, the 5-year cumulative incidence of relapse was 80.8 ± 8.5 % and 28.8 ± 9.9 %, respectively, in the standard and the intensified group (P = 0.380, P = 0.029, P = 0.005, and P < 0.001). Both univariate and multivariate analysis indicated that the intensified conditioning regimen and acute graft-versus-host disease were favorable factors to reduce the relapse. The younger patients, patients with CR at the time of transplantation, and the intensified conditioning regimen were favorable factors to elevate the survival. In conclusion, intensified conditioning regimens followed by allo-HSCT might improve long-term survival and decrease relapse of leukemia in adult ALAL compared to the standard conditioning regimens.
关于急性双表型白血病（ALAL）的临床和生物学特征的知识有限，因此在治疗方面缺乏一致性。在本报告中，我们回顾性研究了强化预处理对接受异基因造血干细胞移植（allo-HSCT）的成人 ALAL 的影响。共有 59 例 ALAL 患者（男 37 例，女 22 例）连续纳入数据分析。24 例患者接受标准预处理（全身照射（TBI）+环磷酰胺（CY）或白消安+CY 方案），35 例患者接受强化预处理（TBI+CY+依托泊苷或氟达拉滨+阿糖胞苷+TBI+CY+依托泊苷方案）。移植相关死亡率为 17.6%±9.6%和 25.5%±8.0%，移植后 5 年总生存率分别为 23.8%±8.9%和 64.0%±8.4%，无病生存率分别为 16.7%±7.6%和 55.8%±9.4%，复发累积发生率分别为 80.8%±8.5%和 28.8%±9.9%，标准组和强化组之间差异无统计学意义（P=0.380，P=0.029，P=0.005，P<0.001）。单因素和多因素分析均表明，强化预处理方案和急性移植物抗宿主病是降低复发的有利因素。年轻患者、移植时处于完全缓解（CR）的患者和强化预处理方案是提高生存的有利因素。总之，与标准预处理方案相比，强化预处理方案联合 allo-HSCT 可能改善成人 ALAL 的长期生存并降低白血病复发率。
