Ge Ling, Ye Fan, Mao Xinliang, Chen Jia, Sun Aining, Zhu Xiaming, Qiu Huiying, Jin Zhengming, Miao Miao, Fu Chengcheng, Ma Xiao, Chen Feng, Xue Shengli, Ruan Changgeng, Wu Depei, Tang Xiaowen
Department of Hematology, First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Collaborative Innovation Center of Hematology, Key Laboratory of Thrombosis and Hemostasis, Ministry of Health, Suzhou, China.
Cyrus Tang Hematology Center, Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Soochow University, Suzhou, China.
Biol Blood Marrow Transplant. 2014 Jul;20(7):1040-7. doi: 10.1016/j.bbmt.2014.03.030. Epub 2014 Apr 2.
Extramedullary relapse (EMR) of acute leukemia (AL) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a contributor to post-transplantation mortality and remains poorly understood, especially the different characteristics of EMR in patients with acute myelogenous leukemia (AML) and those with acute lymphoblastic leukemia (ALL). To investigate the incidence, risk factors, and clinical outcomes of EMR for AML and ALL, we performed a retrospective analysis of 362 patients with AL who underwent allo-HSCT at the First affiliated Hospital of Soochow University between January 2001 and March 2012. Compared with patients with AML, those with ALL had a higher incidence of EMR (12.9% versus 4.6%; P = .009). The most common site of EMR was the central nervous system, especially in the ALL group. Multivariate analyses identified the leading risk factors for EMR in the patients with AML as advanced disease status at HSCT, hyperleukocytosis at diagnosis, history of extramedullary leukemia before HSCT, and a total body irradiation-based conditioning regimen, and the top risk factors for EMR in the patients with ALL as hyperleukocytosis at diagnosis, adverse cytogenetics, and transfusion of peripheral blood stem cells. The prognosis for EMR of AL is poor, and treatment options are very limited; however, the estimated 3-year overall survival (OS) was significantly lower in patients with AML compared with those with ALL (0 versus 18.5%; P = .000). The characteristics of post-allo-HSCT EMR differed between the patients with AML and those with ALL, possibly suggesting different pathogenetic mechanisms for EMR of AML and EMR of ALL after allo-HSCT; further investigation is needed.
异基因造血干细胞移植（allo-HSCT）后急性白血病（AL）的髓外复发（EMR）是导致移植后死亡的一个因素，目前对此仍知之甚少，尤其是急性髓系白血病（AML）患者和急性淋巴细胞白血病（ALL）患者EMR的不同特征。为了研究AML和ALL患者EMR的发生率、危险因素及临床结局，我们对2001年1月至2012年3月在苏州大学第一附属医院接受allo-HSCT的362例AL患者进行了回顾性分析。与AML患者相比，ALL患者的EMR发生率更高（12.9%对4.6%；P = 0.009）。EMR最常见的部位是中枢神经系统，尤其是在ALL组。多因素分析确定AML患者EMR的主要危险因素为HSCT时疾病分期较晚、诊断时白细胞增多、HSCT前有髓外白血病病史以及基于全身照射的预处理方案，ALL患者EMR的主要危险因素为诊断时白细胞增多、不良细胞遗传学以及外周血干细胞输注。AL患者EMR的预后较差，治疗选择非常有限；然而，AML患者的估计3年总生存率（OS）明显低于ALL患者（0对18.5%；P = 0.000）。AML患者和ALL患者allo-HSCT后EMR的特征不同，这可能提示allo-HSCT后AML的EMR和ALL的EMR有不同的发病机制；需要进一步研究。
