Seftel Matthew D, Neuberg Donna, Zhang Mei-Jie, Wang Hai-Lin, Ballen Karen Kuhn, Bergeron Julie, Couban Stephen, Freytes César O, Hamadani Mehdi, Kharfan-Dabaja Mohamed A, Lazarus Hillard M, Nishihori Taiga, Paulson Kristjan, Saber Wael, Sallan Stephen E, Soiffer Robert, Tallman Martin S, Woolfrey Ann E, DeAngelo Daniel J, Weisdorf Daniel J
Department of Medical Oncology and Haematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada.
Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachutsetts.
Am J Hematol. 2016 Mar;91(3):322-9. doi: 10.1002/ajh.24285.
For adults with Philadelphia chromosome-negative (Ph-) acute lymphoblastic leukemia (ALL) in first complete remission (CR1), allogeneic hematopoietic cell transplantation (HCT) is an established curative strategy. However, pediatric-inspired chemotherapy may also offer durable leukemia-free survival in the absence of HCT. We compared 422 HCT recipients aged 18-50 years with Ph-ALL in CR1 reported to the CIBMTR with an age-matched concurrent cohort of 108 Ph- ALL CR1 patients who received a Dana-Farber Consortium pediatric-inspired non-HCT regimen. At 4 years of follow-up, incidence of relapse after HCT was 24% (95% CI 19-28) versus 23% (95% CI 15-32) for the non-HCT (chemo) cohort (P=0.97). Treatment-related mortality (TRM) was higher in the HCT cohort [HCT 37% (95% CI 31-42) versus chemo 6% (95% CI 3-12), P<0.0001]. DFS in the HCT cohort was 40% (95% CI 35-45) versus 71% (95% CI 60-79) for chemo, P<0.0001. Similarly, OS favored chemo [HCT 45% (95% CI 40-50)] versus chemo 73% [(95% CI 63-81), P<0.0001]. In multivariable analysis, the sole factor predictive of shorter OS was the administration of HCT [hazard ratio 3.12 (1.99-4.90), P<0.0001]. For younger adults with Ph- ALL, pediatric-inspired chemotherapy had lower TRM, no increase in relapse, and superior overall survival compared to HCT. Am. J. Hematol. 91:322-329, 2016. © 2015 Wiley Periodicals, Inc.
对于处于首次完全缓解期（CR1）的费城染色体阴性（Ph-）成人急性淋巴细胞白血病（ALL）患者，异基因造血细胞移植（HCT）是一种既定的治愈策略。然而，借鉴儿科化疗方案在不进行HCT的情况下也可能实现持久的无白血病生存。我们将向国际骨髓移植登记处（CIBMTR）报告的422例年龄在18 - 50岁、处于CR1期的Ph-ALL HCT受者与108例接受达纳-法伯联盟儿科启发式非HCT方案的年龄匹配的同期Ph-ALL CR1患者队列进行了比较。在4年的随访中，HCT后复发率为24%（95%置信区间19 - 28），而非HCT（化疗）队列的复发率为23%（95%置信区间15 - 32）（P = 0.97）。HCT队列的治疗相关死亡率（TRM）更高[HCT为37%（95%置信区间31 - 42），化疗为6%（95%置信区间3 - 12），P < 0.0001]。HCT队列的无病生存期（DFS）为40%（95%置信区间35 - 45），化疗组为71%（95%置信区间60 - 79），P < 0.0001。同样，总生存期（OS）有利于化疗组[HCT为45%（95%置信区间40 - 50）]，化疗组为73%[（95%置信区间63 - 81），P < 0.0001]。在多变量分析中，唯一预测OS较短的因素是进行HCT[风险比3.12（1.99 - 4.90），P < 0.0001]。对于年轻的Ph-ALL成人患者，与HCT相比，借鉴儿科化疗方案具有更低的TRM，复发率没有增加，并且总生存期更优。《美国血液学杂志》91:322 - 329，2016年。©2015威利期刊公司。
