Zuckerman Tsila, Beyar-Katz Ofrat, Rowe Jacob M
aDepartment of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa bDepartment of Hematology, Shaare Zedek Medical Center, Jerusalem cBruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
Curr Opin Hematol. 2016 Mar;23(2):88-94. doi: 10.1097/MOH.0000000000000212.
Despite numerous studies, the best postremission therapy in acute myeloid leukemia (AML) is a subject of intense controversy. Major prognostic factors for disease outcome are the genetic alterations of AML, patient's age, and performance status. AML is more common in older adults, with a median age of 72 years. However, in this age group the unfavorable cytogenetics dominates at a time when biologically it may be most difficult to administer optimal intensive therapy.
Autologous stem cell transplantation (ASCT) enables the administration of high-dose therapy supported by stem cell infusion with a treatment-related toxicity not significantly higher than that associated with chemotherapy and significantly lower than in allogeneic stem cell transplantation. The dilemma of best postremission therapy has not been resolved because of the paucity of randomized controlled studies, especially in various cytogenetic risk and age groups. Instead, the use of genetic randomization by donor availability, analysis of outcome based on intention-to-treat, and mixed populations in the registry data produce variable results.
ASCT has been associated with prolonged disease-free survival as compared to chemotherapy, especially in the favorable and intermediate risk groups. Advances in immunotherapy in AML may propel ASCT as a platform for various immunologic maneuvers.
尽管进行了大量研究，但急性髓系白血病（AML）缓解后最佳治疗方法仍是激烈争论的话题。疾病预后的主要预后因素是AML的基因改变、患者年龄和体能状态。AML在老年人中更为常见，中位年龄为72岁。然而，在这个年龄组中，不利的细胞遗传学特征占主导地位，而此时从生物学角度来看，实施最佳强化治疗可能最为困难。
自体干细胞移植（ASCT）能够在干细胞输注支持下进行高剂量治疗，其治疗相关毒性并不显著高于化疗，且明显低于异基因干细胞移植。由于缺乏随机对照研究，尤其是在不同细胞遗传学风险和年龄组中的研究，缓解后最佳治疗方法的困境尚未得到解决。相反，根据供体可用性进行基因随机化、基于意向性治疗分析结果以及登记数据中的混合人群会产生不同的结果。
与化疗相比，ASCT与延长无病生存期相关，尤其是在预后良好和中等风险组中。AML免疫治疗的进展可能会推动ASCT成为各种免疫策略的平台。
