Bejanyan Nelli, Weisdorf Daniel J, Logan Brent R, Wang Hai-Lin, Devine Steven M, de Lima Marcos, Bunjes Donald W, Zhang Mei-Jie
Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota.
Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota.
Biol Blood Marrow Transplant. 2015 Mar;21(3):454-9. doi: 10.1016/j.bbmt.2014.11.007. Epub 2014 Nov 15.
Acute myeloid leukemia (AML) relapse after allogeneic hematopoietic cell transplantation (alloHCT) remains a major therapeutic challenge. We studied outcomes of 1788 AML patients relapsing after alloHCT (1990 to 2010) during first or second complete remission (CR) to identify factors associated with longer postrelapse survival. Median time to post-HCT relapse was 7 months (range, 1 to 177). At relapse, 1231 patients (69%) received intensive therapy, including chemotherapy alone (n = 660), donor lymphocyte infusion (DLI) ± chemotherapy (n = 202), or second alloHCT ± chemotherapy ± DLI (n = 369), with subsequent CR rates of 29%. Median follow-up after relapse was 39 months (range, <1 to 193). Survival for all patients was 23% at 1 year after relapse; however, 3-year overall survival correlated with time from HCT to relapse (4% for relapse during the 1- to 6-month period, 12% during the 6-month to 2-year period, 26% during the 2- to 3-year period, and 38% for ≥3 years). In multivariable analysis, lower mortality was significantly associated with longer time from alloHCT to relapse (relative risk, .55 for 6 months to 2 years; relative risk, .39 for 2 to 3 years; and relative risk, .28 for ≥3 years; P < .0001) and a first HCT using reduced-intensity conditioning (relative risk, .77; 95% confidence interval [CI], .66 to .88; P = .0002). In contrast, inferior survival was associated with age >40 years (relative risk, 1.42; 95% CI, 1.24 to 1.64; P < .0001), active graft-versus-host disease at relapse (relative risk, 1.25; 95% CI, 1.13 to 1.39; P < .0001), adverse cytogenetics (relative risk, 1.37; 95% CI, 1.09 to 1.71; P = .0062), mismatched unrelated donor (relative risk, 1.61; 95% CI, 1.22 to 2.13; P = .0008), and use of cord blood for first HCT (relative risk, 1.23; 95% CI, 1.06 to 1.42; P = .0078). AML relapse after alloHCT predicted poor survival; however, patients who relapsed ≥6 months after their initial alloHCT had better survival and may benefit from intensive therapy, such as second alloHCT ± DLI.
异基因造血细胞移植（alloHCT）后急性髓系白血病（AML）复发仍然是一个重大的治疗挑战。我们研究了1788例在首次或第二次完全缓解（CR）期接受alloHCT（1990年至2010年）后复发的AML患者的预后，以确定与复发后较长生存期相关的因素。alloHCT后复发的中位时间为7个月（范围1至177个月）。复发时，1231例患者（69%）接受了强化治疗，包括单纯化疗（n = 660）、供体淋巴细胞输注（DLI）±化疗（n = 202）或第二次alloHCT±化疗±DLI（n = 369），随后的CR率为29%。复发后的中位随访时间为39个月（范围<1至193个月）。所有患者在复发后1年的生存率为23%；然而，3年总生存率与从HCT到复发的时间相关（1至6个月复发时为4%，6个月至2年期间为12%，2至3年期间为26%，≥3年为38%）。在多变量分析中，较低死亡率与从alloHCT到复发的较长时间显著相关（6个月至2年时相对风险为0.55；2至3年时相对风险为0.39；≥3年时相对风险为0.28；P <.0001）以及首次HCT采用减低强度预处理（相对风险为0.77；95%置信区间[CI]，0.66至0.88；P =.0002）。相比之下，较差的生存率与年龄>40岁（相对风险为1.42；95%CI，1.24至1.64；P <.
