Section of Haematology/Oncology, Department of Internal Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada; CancerCare Manitoba, Winnipeg, MB, Canada.
Section of Haematology/Oncology, Department of Internal Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada; CancerCare Manitoba, Winnipeg, MB, Canada.
Leuk Res. 2014 Feb;38(2):176-9. doi: 10.1016/j.leukres.2013.10.021. Epub 2013 Nov 1.
Adults with acute lymphoblastic leukemia (ALL) in first complete remission (CR1) may be treated either with ongoing systemic chemotherapy or with allogeneic hematopoietic cell transplantation (alloHCT). Despite the presence of phase III trials to support clinical decision-making, we hypothesized that physicians who treat adult ALL would demonstrate wide practice variation. Canadian hematologists who treat ALL were surveyed electronically. Overall, 69 of 173 physicians responded (40%). There was high agreement with offering alloHCT for ALL with high-risk cytogenetics or induction failure after a single chemotherapy cycle. However, only a minority of respondents felt that age >35 years was an indication for alloHCT in CR1. Almost all respondents (96%) felt that a well-matched unrelated donor was an acceptable alternative to a sibling donor. There was uncertainty about the role of cord blood (53% agree) and the utility of reduced intensity conditioning HCT (41% agree). In contrast to the results of the MRC/ECOG study, respondents considered alloHCT to be particularly helpful in high-risk patients. Consensus was lacking on the use of cord blood, RIC alloHCT, and the application of MRD. Equipoise exists on the role of alloHCT in CR1 in ALL, suggesting that further trials in this area are required.
成人急性淋巴细胞白血病（ALL）在首次完全缓解（CR1）期可接受持续全身性化疗或异体造血细胞移植（alloHCT）治疗。尽管有支持临床决策的 III 期试验，但我们假设治疗成人 ALL 的医生会表现出广泛的实践差异。我们对治疗 ALL 的加拿大血液科医生进行了电子调查。共有 173 名医生中的 69 名（40%）做出了回应。对于高危细胞遗传学或单次化疗周期后诱导失败的 ALL，提供 alloHCT 具有高度共识。然而，只有少数受访者认为年龄>35 岁是 CR1 期 alloHCT 的指征。几乎所有受访者（96%）认为匹配良好的无关供者是同胞供者的可接受替代方案。对于脐带血（53%的人同意）和低强度预处理 HCT（41%的人同意）的作用存在不确定性。与 MRC/ECOG 研究的结果相反，受访者认为 alloHCT 对高危患者特别有帮助。在使用脐带血、RIC alloHCT 和 MRD 应用方面，尚未达成共识。alloHCT 在 ALL 的 CR1 中的作用存在争议，这表明需要在该领域进行进一步的试验。
