Labopin M, Gorin N-C, Polge E, Socié G, Gurman G, Gluckman E, Jindra P, Poiré X, Schäfer-Eckart K, Ruutu T, Milone G, Arcese W, Mohty M, Rocha V
1] Paris EBMT Data Coordination Office, Hospital Saint-Antoine, APHP, Université Pierre et Marie Curie UPMC and INSERM U 938, Paris, France [2] Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris, France.
Paris EBMT Data Coordination Office, Hospital Saint-Antoine, APHP, Université Pierre et Marie Curie UPMC and INSERM U 938, Paris, France.
Bone Marrow Transplant. 2014 Mar;49(3):376-81. doi: 10.1038/bmt.2013.178. Epub 2013 Nov 18.
For adults with acute leukemia, it is important to know whether the therapeutic schemes initially planned were actually implemented. The European Group for Blood and Marrow transplantation Acute Leukemia Working Party prospectively followed 695 consecutive patients who were registered at the time of HLA typing. Of 304 patients with an available matched sibling donor (MSD), SCT was planned in 264, chemotherapy in 33 and autografting in 7. For the rest, an unrelated donor (UD) search was initiated in 198. Among these, 117 were transplanted, 114 received chemotherapy and 77 underwent autografting. Probabilities of receiving a planned treatment were 60 and 65% at 1 and 2 years, respectively. Patients scheduled to receive MSD SCT had an 82% probability, whereas those scheduled to undergo UD SCT had a 57% probability, of receiving their transplant at 1 year. The only factor associated with a lower probability of MSD SCT in first remission was delayed HLA typing (HR=0.82; P=0.03). One year after enrollment, 40% of patients did not follow their initial treatment plan. Because OS was 50% only at 3 years and only 57% of the patients without a MSD underwent SCT, this suggests room for improvement in outcomes for adults with acute leukemia.
对于成年急性白血病患者而言，了解最初计划的治疗方案是否真正得到实施至关重要。欧洲血液与骨髓移植学会急性白血病工作组对695例在进行HLA分型时登记的连续患者进行了前瞻性随访。在304例有可用的同胞全相合供者（MSD）的患者中，计划进行异基因造血干细胞移植（SCT）的有264例，计划进行化疗的有33例，计划进行自体造血干细胞移植的有7例。其余患者中，198例启动了无关供者（UD）搜索。其中，117例接受了移植，114例接受了化疗，77例接受了自体造血干细胞移植。在1年和2年时接受计划治疗的概率分别为60%和65%。计划接受MSD-SCT的患者在1年时接受移植的概率为82%，而计划接受UD-SCT的患者这一概率为57%。首次缓解期MSD-SCT概率较低的唯一相关因素是HLA分型延迟（风险比=0.82；P=0.03）。入组1年后，40%的患者未遵循其初始治疗计划。由于3年时总生存率仅为50%，且没有MSD的患者中只有57%接受了SCT，这表明成年急性白血病患者的治疗效果仍有改善空间。
