Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Gliwice, Poland.
Clinical Hematology and Cellular Therapy Department, The Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation Office, Hopital Saint-Antoine APHP, Paris, France.
Cancer. 2016 Jun 15;122(12):1880-7. doi: 10.1002/cncr.29990. Epub 2016 Mar 28.
Leukemia recurrence is a major cause of treatment failure after autologous stem cell transplantation for acute myeloid leukemia (AML). It usually occurs within the first 2 years after transplantation. The goal of the current retrospective study was to assess the follow-up of and characterize risk factors for outcome among patients who survived free of disease recurrence after this period.
The analysis included 3567 adults (median age, 45 years) with AML who underwent autografting during the first (86% of patients) or second (14% of patients) complete remission between 1990 and 2008. The stem cell source was the bone marrow in 32% of patients or the peripheral blood in 68% of patients. The median follow-up was 6.9 years.
At 5 years and 10 years after transplantation, the probability of leukemia-free survival was 86% and 76%, respectively; the recurrence incidence was 11% and 16%, respectively; and the nonrecurrence mortality rate was 3% and 8%, respectively. The observed survival was decreased compared with the expected survival of the general European population. In a multivariate analysis, decreased probability of leukemia-free survival was demonstrated for patients who underwent peripheral blood autologous stem cell transplantation; had French-American-British subtypes M0, M6, or M7; and were of an older age. The same factors were found to be associated with an increased risk of disease recurrence. Nonrecurrence mortality was found to be affected by older age.
The results of the current analysis indicate that late recurrences remain a major concern after autologous stem cell transplantation among patients with AML, indicating the need for close monitoring of minimal residual disease and additional leukemic control measures after transplantation. Cancer 2016;122:1880-7. © 2016 American Cancer Society.
白血病复发是急性髓细胞白血病（AML）患者自体干细胞移植后治疗失败的主要原因。它通常发生在移植后 2 年内。本回顾性研究的目的是评估在此期间无疾病复发存活患者的随访情况，并分析其结局的危险因素。
该分析纳入了 1990 年至 2008 年期间在第一次（86%的患者）或第二次完全缓解期（14%的患者）接受自体移植的 3567 例 AML 成人患者（中位年龄为 45 岁）。干细胞来源为骨髓 32%，外周血 68%。中位随访时间为 6.9 年。
移植后 5 年和 10 年，无白血病生存率分别为 86%和 76%，复发率分别为 11%和 16%，无复发死亡率分别为 3%和 8%。观察到的生存率低于欧洲普通人群的预期生存率。多变量分析显示，接受外周血自体干细胞移植、FAB 亚型为 M0、M6 或 M7、年龄较大的患者，无白血病生存率降低。同样的因素也与疾病复发风险增加相关。无复发死亡率受年龄影响。
本分析结果表明，AML 患者自体干细胞移植后仍存在迟发性复发的主要问题，这表明需要在移植后密切监测微小残留病，并采取额外的白血病控制措施。癌症 2016；122:1880-7。©2016 美国癌症协会。
