Mo Xiao-Dong, Kong Jun, Zhao Ting, Xu Lan-Ping, Zhang Xiao-Hui, Liu Dai-Hong, Wang Yu, Chen Huan, Yan Chen-Hua, Chen Yu-Hong, Han Wei, Wang Feng-Rong, Wang Jing-Zhi, Liu Kai-Yan, Huang Xiao-Jun
Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.
Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; Peking-Tsinghua Center for Life Sciences, Beijing, China.
Biol Blood Marrow Transplant. 2014 Dec;20(12):2023-8. doi: 10.1016/j.bbmt.2014.08.023. Epub 2014 Sep 6.
We examined the incidence, risk factors, treatment, and clinical outcomes of extramedullary relapse (EMR) in 961 acute leukemia patients undergoing HLA-haploidentical hematopoietic stem cell transplantation (haplo-HSCT) between 2002 and 2013. Multiple control subjects were selected at random from the same cohort and matched to EMR cases for diagnosis, disease status at HSCT, age at the time of the HSCT, and year of HSCT. Forty patients exhibited EMR, with a median time to EMR of 207 days. The cumulative incidence of EMR was 4.0% at 3 years, and the incidence was higher in acute lymphoblastic leukemia patients compared with acute myeloid leukemia patients (5.6% versus 2.4%). In the multivariate analysis, non-complete remission (CR) status at HSCT (hazard ratio [HR] = 4.6; P = .018) and non-chronic graft-versus-host disease after HSCT (HR = 3.2; P < .001) were the independent risk factors for EMR after haplo-HSCT. Twenty-seven patients received combination treatments, and the proportion of patients who achieved CR was higher than those who received single treatment. Multifocal involvement at EMR (HR = 2.7; P = .024) and non-CR after EMR treatments (HR = 4.6; P < .001) were the independent risk factors for poor survival rates among EMR patients. We found that graft-versus-leukemia effect may help to prevent EMR after haplo-HSCT.
我们对2002年至2013年间接受HLA单倍型相合造血干细胞移植（haplo-HSCT）的961例急性白血病患者的髓外复发（EMR）的发生率、危险因素、治疗及临床结局进行了研究。从同一队列中随机选取多个对照对象，并与EMR病例在诊断、HSCT时的疾病状态、HSCT时的年龄及HSCT年份方面进行匹配。40例患者出现EMR，EMR的中位时间为207天。3年时EMR的累积发生率为4.0%，急性淋巴细胞白血病患者的发生率高于急性髓细胞白血病患者（5.6%对2.4%）。多因素分析显示，HSCT时未达到完全缓解（CR）状态（风险比[HR]=4.6；P=0.018）及HSCT后未发生慢性移植物抗宿主病（HR=3.2；P<0.001）是haplo-HSCT后EMR的独立危险因素。27例患者接受了联合治疗，达到CR的患者比例高于接受单一治疗的患者。EMR时多灶性受累（HR=2.7；P=0.024）及EMR治疗后未达到CR（HR=4.6；P<0.001）是EMR患者生存率低的独立危险因素。我们发现移植物抗白血病效应可能有助于预防haplo-HSCT后的EMR。
