Department of Cancer Prevention, School of Public Health, Medical University of Silesia, Katowice, Poland.
Department of Bone Marrow Transplantation, Branch Gliwice, Comprehensive Cancer Center M. Sklodowska-Curie Memorial Institute, Gliwice, Poland.
Am J Hematol. 2015 Oct;90(10):904-9. doi: 10.1002/ajh.24113.
The importance of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for survival outcomes in patients with acute myeloid leukemia (AML) currently remains unclear. The study aimed to compare measures of clinical treatment for patients with AML in CR1 (the first complete remission) with or without being subjected to allo-HSCT. These consisted of leukemia-free survival (LFS), overall survival (OS), cumulative incidence of relapse (CIR), and non-relapse mortality disease (NRM). Subjects were 622 patients, median age of 44, forming part of the prospective, randomized, and multicenter clinical Polish Adult Leukemia Group trials during 1999-2008. The Mantel-Byar approach was used to assess allo-HSCT on survival endpoints, accounting for a changing transplant status. Undergoing allo-HSCT significantly improved the LFS and OS for the entire group of patients with AML in CR1, along with the DAC induction subgroup and for the group with unfavorable cytogenetics aged 41-60. The CIR demonstrated that allo-HSCT reduced the risk of relapse for patients with AML in CR1 and those with an unfavorable cytogenetic risk. In addition, the NRM analysis showed that allo-HSCT significantly reduced the risk of death unrelated to relapse for the entire group of AML patients in CR1 and aged 41-60. The allo-HSCT treatment particularly benefitted survival for the AML in CR1 group having an unfavorable cytogenetic prognosis.
异基因造血干细胞移植(allo-HSCT)对急性髓细胞白血病(AML)患者生存结局的重要性目前仍不清楚。本研究旨在比较伴有或不伴有 allo-HSCT 的 AML 患者在 CR1(首次完全缓解)的临床治疗措施,这些措施包括无白血病生存(LFS)、总生存(OS)、累积复发率(CIR)和非复发死亡率(NRM)。受试者为 622 名中位年龄为 44 岁的患者,他们参加了 1999-2008 年期间前瞻性、随机、多中心的波兰成人白血病组临床试验。采用 Mantel-Byar 方法评估 allo-HSCT 对生存终点的影响,同时考虑到移植状态的变化。allo-HSCT 显著改善了 AML 在 CR1 期的所有患者、DAC 诱导亚组以及年龄在 41-60 岁、细胞遗传学不良的患者的 LFS 和 OS。CIR 表明 allo-HSCT 降低了 AML 在 CR1 期和细胞遗传学不良风险患者的复发风险。此外,NRM 分析表明,allo-HSCT 显著降低了 AML 在 CR1 期和年龄在 41-60 岁的所有患者的与复发无关的死亡风险。allo-HSCT 治疗特别有益于 AML 在 CR1 期且细胞遗传学预后不良的患者的生存。