Takashima Shuichiro, Miyamoto Toshihiro, Kamimura Tomohiko, Yoshimoto Goichi, Yoshida Shuro, Henzan Hideho, Takase Ken, Kato Koji, Ito Yoshikiyo, Ohno Yuju, Nagafuji Koji, Eto Tetsuya, Techima Takanori, Akashi Koichi
Int J Hematol. 2015 Dec;102(6):689-96. doi: 10.1007/s12185-015-1883-0.
We retrospectively analyzed the outcomes of patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL) who underwent first allogeneic stem cell transplantation (allo-SCT) at complete remission (CR) with myeloablative conditioning (MAC, n = 31) or reduced-intensity conditioning (RIC, n = 15) between 2001 and 2012. All the patients had received tyrosine kinase inhibitor (TKI)-based chemotherapy prior to allo-SCT. Overall survival (OS) rates (57 vs 63%, p = 0.53), leukemia-free survival rates (50 vs 65%, p = 0.29), and non-relapse mortality rates (39 vs 35%, p = 0.62) at 2 years were similar between the MAC and RIC groups. The minimal residual disease (MRD) status evaluated by sensitive polymerase chain reaction prior to allo-SCT did not influence the OS rate (77 vs 54%, p = 0.28) and leukemia-free survival rate (69 vs 51%, p = 0.48), irrespective of the conditioning intensity. Our data suggest that the RIC regimen may represent a sufficient intensity of therapeutic pre-transplant conditioning for patients with Ph+ALL who have maintained a hematological CR with TKI-combined chemotherapy.
我们回顾性分析了2001年至2012年间接受首次异基因干细胞移植（allo-SCT）的费城染色体阳性急性淋巴细胞白血病（Ph+ALL）患者的结局，这些患者在完全缓解（CR）时接受了清髓性预处理（MAC，n = 31）或减低强度预处理（RIC，n = 15）。所有患者在allo-SCT之前均接受了基于酪氨酸激酶抑制剂（TKI）的化疗。MAC组和RIC组在2年时的总生存率（OS）（57% 对 63%，p = 0.53）、无白血病生存率（50% 对 65%，p = 0.29）和非复发死亡率（39% 对 35%，p = 0.62）相似。在allo-SCT之前通过敏感聚合酶链反应评估的微小残留病（MRD）状态，无论预处理强度如何，均不影响OS率（77% 对 54%，p = 0.28）和无白血病生存率（69% 对 51%，p = 0.48）。我们的数据表明，对于通过TKI联合化疗维持血液学CR的Ph+ALL患者，RIC方案可能代表了足够强度的移植前治疗预处理。
