Pasquini Marcelo C, Zhang Mei-Jie, Medeiros Bruno C, Armand Philippe, Hu Zhen-Huan, Nishihori Taiga, Aljurf Mahmoud D, Akpek Görgün, Cahn Jean-Yves, Cairo Mitchell S, Cerny Jan, Copelan Edward A, Deol Abhinav, Freytes César O, Gale Robert Peter, Ganguly Siddhartha, George Biju, Gupta Vikas, Hale Gregory A, Kamble Rammurti T, Klumpp Thomas R, Lazarus Hillard M, Luger Selina M, Liesveld Jane L, Litzow Mark R, Marks David I, Martino Rodrigo, Norkin Maxim, Olsson Richard F, Oran Betul, Pawarode Attaphol, Pulsipher Michael A, Ramanathan Muthalagu, Reshef Ran, Saad Ayman A, Saber Wael, Savani Bipin N, Schouten Harry C, Ringdén Olle, Tallman Martin S, Uy Geoffrey L, Wood William A, Wirk Baldeep, Pérez Waleska S, Batiwalla Minoo, Weisdorf Daniel J
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.
Biol Blood Marrow Transplant. 2016 Feb;22(2):248-257. doi: 10.1016/j.bbmt.2015.08.024. Epub 2015 Aug 29.
The presence of monosomal karyotype (MK+) in acute myeloid leukemia (AML) is associated with dismal outcomes. We evaluated the impact of MK+ in AML (MK+AML, n = 240) and in myelodysplastic syndrome (MDS) (MK+MDS, n = 221) on hematopoietic cell transplantation outcomes compared with other cytogenetically defined groups (AML, n = 3360; MDS, n = 1373) as reported to the Center for International Blood and Marrow Transplant Research from 1998 to 2011. MK+ AML was associated with higher disease relapse (hazard ratio, 1.98; P < .01), similar transplantation-related mortality (TRM) (hazard ratio, 1.01; P = .90), and worse survival (hazard ratio, 1.67; P < .01) compared with those outcomes for other cytogenetically defined AML. Among patients with MDS, MK+ MDS was associated with higher disease relapse (hazard ratio, 2.39; P < .01), higher TRM (hazard ratio, 1.80; P < .01), and worse survival (HR, 2.02; P < .01). Subset analyses comparing chromosome 7 abnormalities (del7/7q) with or without MK+ demonstrated higher mortality for MK+ disease in for both AML (hazard ratio, 1.72; P < .01) and MDS (hazard ratio, 1.79; P < .01). The strong negative impact of MK+ in myeloid malignancies was observed in all age groups and using either myeloablative or reduced-intensity conditioning regimens. Alternative approaches to mitigate disease relapse in this population are needed.
急性髓系白血病（AML）中单体核型（MK+）的存在与预后不良相关。我们评估了AML（MK+AML，n = 240）和骨髓增生异常综合征（MDS）（MK+MDS，n = 221）中MK+对造血细胞移植结果的影响，并与1998年至2011年向国际血液和骨髓移植研究中心报告的其他细胞遗传学定义组（AML，n = 3360；MDS，n = 1373）进行比较。与其他细胞遗传学定义的AML相比，MK+ AML与更高的疾病复发率（风险比，1.98；P <.01）、相似的移植相关死亡率（TRM）（风险比，1.01；P =.90）和更差的生存率（风险比，1.67；P <.01）相关。在MDS患者中，MK+ MDS与更高的疾病复发率（风险比，2.39；P <.01）、更高的TRM（风险比，1.80；P <.01）和更差的生存率（HR，2.02；P <.01）相关。比较有或无MK+的7号染色体异常（del7/7q）的亚组分析表明，AML（风险比，1.72；P <.01）和MDS（风险比，1.79；P <.01）中MK+疾病的死亡率更高。在所有年龄组中，无论采用清髓性还是降低强度的预处理方案，都观察到MK+对髓系恶性肿瘤有强烈的负面影响。需要采取替代方法来减轻该人群的疾病复发。
