Choi Yunsuk, Kim Sung-Doo, Park Young-Hoon, Lee Jae Seok, Kim Dae-Young, Lee Jung-Hee, Lee Kyoo-Hyung, Seol Miee, Lee Young-Shin, Kang Young-Ah, Jeon Mijin, Jung Ah Rang, Lee Je-Hwan
Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Acta Haematol. 2015;133(2):183-92. doi: 10.1159/000362260. Epub 2014 Oct 11.
In patients with secondary acute myeloid leukemia (s-AML) arising from the myelodysplastic syndrome (MDS), treatment outcome is unsatisfactory. We compared up-front allogeneic hematopoietic cell transplantation (HCT) to induction chemotherapy (IC) as an initial treatment in patients with s-AML arising from MDS. This retrospective study included 85 patients who were diagnosed with s-AML arising from MDS; 11 patients proceeded to up-front HCT without IC (HCT group) and 74 received IC (IC group) as an initial treatment for s-AML, 28 of whom subsequently underwent HCT. In the IC group, 41.9% achieved complete remission (CR) compared to 81.8% in the HCT group (p = 0.013). The HCT group showed a significantly longer event-free survival (EFS) than the IC group (median 29.2 vs. 5.2 months, p = 0.042). Overall survival of the HCT group was higher than that of the IC group, but the difference was not statistically significant (median 34.6 vs. 7.6 months, p = 0.149). After adjustment for other clinical factors, outcome in the HCT group was significantly better than in the IC group in terms of CR rate (hazard ratio, HR, 11.195; p = 0.007) and EFS (HR, 0.384; p = 0.029). Up-front HCT is a viable option in s-AML arising from MDS if an appropriate donor is available.
在由骨髓增生异常综合征（MDS）引发的继发性急性髓系白血病（s-AML）患者中，治疗效果并不理想。我们比较了直接进行异基因造血细胞移植（HCT）与诱导化疗（IC）作为MDS相关s-AML患者的初始治疗方法。这项回顾性研究纳入了85例被诊断为MDS相关s-AML的患者；11例患者直接进行HCT而未接受IC（HCT组），74例接受IC（IC组）作为s-AML的初始治疗，其中28例随后接受了HCT。在IC组中，41.9%的患者实现了完全缓解（CR），而HCT组为81.8%（p = 0.013）。HCT组的无事件生存期（EFS）明显长于IC组（中位数分别为29.2个月和5.2个月，p = 0.042）。HCT组的总生存期高于IC组，但差异无统计学意义（中位数分别为34.6个月和7.6个月，p = 0.149）。在对其他临床因素进行调整后，HCT组在CR率（风险比，HR，11.195；p = 0.007）和EFS（HR，0.384；p = 0.029）方面的结局明显优于IC组。如果有合适的供体，直接进行HCT是MDS相关s-AML的一个可行选择。
