接受或不接受自体或异基因造血干细胞移植治疗的复发或难治性急性早幼粒细胞白血病患者的结局。
Outcomes in patients with relapsed or refractory acute promyelocytic leukemia treated with or without autologous or allogeneic hematopoietic stem cell transplantation.
机构信息
Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
出版信息
Clin Lymphoma Myeloma Leuk. 2013 Aug;13(4):485-92. doi: 10.1016/j.clml.2013.02.023. Epub 2013 Jun 13.
BACKGROUND
Outcomes in patients with acute promyelocytic leukemia (APL) have improved; however, a significant number of patients still relapse despite receiving all-trans-retinoic acid (ATRA) and arsenic-based therapies.
PATIENTS AND METHODS
Outcomes of patients with relapsed APL who were treated at our institution (1980-2010) and who received HCT were compared with those who received chemotherapy (CT) only.
RESULTS
Among 40 patients, 24 received HCT (autologous [auto] HCT, 7; allogeneic [allo] HCT, 14; both, 3); 16 received CT only. The median age at diagnosis was 36 years (range, 13-50 years), 31 years (range, 16-58 years), and 44 years (range, 24-79 years) for the auto-HCT, allo-HCT, and CT groups, respectively. Ten (100%) patients who received auto-HCT and 12 (71%) who received allo-HCT were in complete remission at the time of the HCT. The median follow-ups in the auto-HCT, allo-HCT, and CT groups were 74 months (range, 26-135 months), 118 months (range, 28-284 months), and 122 months (range, 32-216 months), respectively. Transplantation-related mortality (1 year) after auto-HCT and allo-HCT were 10% and 29%, respectively. The 7-year event-free survival after auto-HCT and allo-HCT was 68.6% and 40.6%, respectively (P = .45). The 7-year overall survival was 85.7%, 49.4%, and 40% in the auto-HCT, allo-HCT, and CT groups, respectively (P = .48).
CONCLUSION
Both auto-HCT and allo-HCT are associated with durable remission and prolonged survival. All 3 strategies (auto-HCT, allo-HCT, CT) were found to be feasible in the relapsed APL setting and result in long-term disease control in selected patients. In this retrospective analysis, overall survival for patients who received HCT was not significantly better than patients who received CT only, but a trend toward better outcomes was seen in patients who underwent auto-HCT, although not statistically significant.
背景
急性早幼粒细胞白血病（APL）患者的预后已经得到改善；然而，尽管接受了全反式维甲酸（ATRA）和砷剂治疗，仍有相当数量的患者复发。
方法
比较了我院（1980-2010 年）收治的接受 HCT 治疗的复发 APL 患者的结局与仅接受化疗（CT）治疗的患者。
结果
在 40 例患者中，24 例接受 HCT（自体[auto]HCT，7 例；异基因[allo]HCT，14 例；两者均为 3 例）；16 例仅接受 CT。auto-HCT、allo-HCT 和 CT 组患者的中位年龄分别为 36 岁（范围 13-50 岁）、31 岁（范围 16-58 岁）和 44 岁（范围 24-79 岁）。10 例（100%）接受 auto-HCT 的患者和 12 例（71%）接受 allo-HCT 的患者在 HCT 时处于完全缓解状态。auto-HCT、allo-HCT 和 CT 组的中位随访时间分别为 74 个月（范围 26-135 个月）、118 个月（范围 28-284 个月）和 122 个月（范围 32-216 个月）。auto-HCT 和 allo-HCT 后的 1 年移植相关死亡率分别为 10%和 29%。auto-HCT 和 allo-HCT 后的 7 年无事件生存率分别为 68.6%和 40.6%（P=0.45）。auto-HCT、allo-HCT 和 CT 组的 7 年总生存率分别为 85.7%、49.4%和 40%（P=0.48）。
结论
自体 HCT 和 allo-HCT 均与持久缓解和延长生存相关。在复发 APL 背景下，3 种策略（自体 HCT、allo-HCT、CT）均可行，并使选定患者的疾病得到长期控制。在这项回顾性分析中，接受 HCT 治疗的患者的总生存率并未明显优于仅接受 CT 治疗的患者，但接受自体 HCT 治疗的患者的生存结局有改善趋势，尽管无统计学意义。
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