Yan Chen-Hua, Jiang Qian, Wang Jing, Xu Lan-Ping, Liu Dai-Hong, Jiang Hao, Chen Huan, Zhang Xiao-Hui, Liu Kai-Yan, Huang Xiao-Jun
Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Hematological Department, Beijing, China.
Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Hematological Department, Beijing, China.
Biol Blood Marrow Transplant. 2014 Sep;20(9):1314-21. doi: 10.1016/j.bbmt.2014.04.011. Epub 2014 Apr 18.
We wanted to compare the efficacy of haploidentical hematopoietic stem cell transplantation (HSCT) with chemotherapy alone in adults with standard-risk acute lymphoblastic leukemia (ALL) in first complete remission (CR1). One hundred thirty-eight consecutive adult patients with standard-risk ALL in CR1 were retrospectively investigated. Of these patients, 59 received chemotherapy alone (group A) and 79 received unmanipulated haploidentical HSCT (group B). Cumulative incidence of relapse at 5 years in group A was significantly higher than that in group B (66.3% versus 29.9%, P < .0001). Overall and disease-free survival in group A were significantly inferior to group B (P < .0001). Moreover, multivariate analyses demonstrated that central nervous system leukemia (P = .002), T cell immunophenotype (P = .044), expression of E2A-PBX1 (P = .007), and positive minimal residual disease after the first cycle of consolidation (P = .004) were correlated with relapse. Patients with 1 of 4 risk factors were assigned to the high-risk group. Otherwise, patients without risk factors were assigned to the low-risk group. In the high-risk group, HSCT had lower relapse rates and superior DFS compared with chemotherapy (P < .05), but in the low-risk group, there were no differences between HSCT and chemotherapy (P > .05). This study is the first to demonstrate that compared with chemotherapy alone, haploidentical HSCT is a better postremission therapy in adults with standard-risk ALL in CR1. Moreover, based on the 4 risk factors, the establishment of risk stratification could identify the subgroup of patients with a higher risk of relapse in adults with standard-risk ALL in CR1. Furthermore, risk stratification-directed postremission therapies using haploidentical HSCT or chemotherapy alone not only reduce relapse rate but also avoid unnecessary treatment-related mortality and improve survival.
我们希望比较单倍体相合造血干细胞移植（HSCT）与单纯化疗对首次完全缓解（CR1）的标准风险成人急性淋巴细胞白血病（ALL）患者的疗效。对138例连续的处于CR1期的标准风险成人ALL患者进行了回顾性研究。这些患者中，59例接受单纯化疗（A组），79例接受未处理的单倍体相合HSCT（B组）。A组5年累积复发率显著高于B组（66.3%对29.9%，P <.0001）。A组的总生存和无病生存均显著低于B组（P <.0001）。此外，多因素分析表明，中枢神经系统白血病（P =.002）、T细胞免疫表型（P =.044）、E2A-PBX1表达（P =.007）以及巩固治疗第一周期后微小残留病阳性（P =.004）与复发相关。具有4个风险因素之一的患者被归为高危组。否则，无风险因素的患者被归为低危组。在高危组中，与化疗相比，HSCT的复发率更低，无病生存更好（P <.05），但在低危组中，HSCT与化疗之间无差异（P >.05）。本研究首次表明，与单纯化疗相比，单倍体相合HSCT对处于CR1期的标准风险成人ALL患者是更好的缓解后治疗方法。此外，基于这4个风险因素建立的风险分层可以识别出处于CR1期的标准风险成人ALL患者中复发风险较高的亚组。此外，采用单倍体相合HSCT或单纯化疗的风险分层导向缓解后治疗不仅可降低复发率，还可避免不必要的治疗相关死亡率并改善生存。
