与减低强度预处理相比，采用清髓性预处理进行 HLA 配型相合的同胞异基因干细胞移植治疗急性髓系白血病后的长期生存及晚期事件：代表欧洲血液与骨髓移植组急性白血病工作组的报告
Long-term survival and late events after allogeneic stem cell transplantation from HLA-matched siblings for acute myeloid leukemia with myeloablative compared to reduced-intensity conditioning: a report on behalf of the acute leukemia working party of European group for blood and marrow transplantation.
作者信息
Shimoni Avichai, Labopin Myriam, Savani Bipin, Volin Liisa, Ehninger Gerhard, Kuball Jurgen, Bunjes Donald, Schaap Nicolaas, Vigouroux Stephane, Bacigalupo Andrea, Veelken Hendrik, Sierra Jorge, Eder Matthias, Niederwieser Dietger, Mohty Mohamad, Nagler Arnon
机构信息
Department of Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel HaShomer and Tel-Aviv University, Tel Aviv, Israel.
Hôpital Saint Antoine, ALWP office, Service d'Hématologie et de Thérapie cellulaire, Paris, France.
出版信息
J Hematol Oncol. 2016 Nov 8;9(1):118. doi: 10.1186/s13045-016-0347-1.
BACKGROUND
Myeloablative (MAC) and reduced-intensity conditioning (RIC) are established approaches for allogeneic stem cell transplantation (SCT) in acute myeloid leukemia (AML). Most deaths after MAC occur within the first 2 years after SCT, while patients surviving leukemia-free for 2 years can expect a favorable long-term outcome. However, there is paucity of data on the long-term outcome (beyond 10 years) and the pattern of late events following RIC due to the relative recent introduction of this approach.
METHODS
We analyzed long-term outcomes in a cohort of 1423 AML patients, age ≥50 years, after SCT from HLA-matched siblings, during the years 1997-2005, median follow-up 8.3 years (0.1-17).
RESULTS
The 10-year leukemia-free survival (LFS) was 31 % (95CI, 27-35) and 32 % (28-35) after MAC and RIC, respectively (P = 0.57). The 10-year GVHD/ relapse-free survival (GRFS), a surrogate for quality of life was 22 % (18-25) and 21 % (18-24), respectively (P = 0.79). The 10-year non-relapse mortality (NRM) was higher and relapse rate was lower after MAC, throughout the early and late post-transplant course. The 10-year LFS among 584 patients surviving leukemia-free 2 years after SCT was 71 % (65-76) and 73 % (67-78) after MAC and RIC, respectively (P = 0.76). Advanced leukemia at SCT was the major predictor of LFS subsequent to the 2-year landmark. Relapse was the major cause of late death after both regimens; however, NRM and in particular chronic graft-versus-host disease and second cancers were more common causes of late death after MAC.
CONCLUSIONS
Long-term LFS and GRFS are similar after RIC and MAC. Most events after RIC or MAC occur within the first 2 years after SCT. Patients who are leukemia-free 2 years after SCT can expect similar good subsequent outcome after both approaches.
背景
清髓性预处理（MAC）和减低强度预处理（RIC）是急性髓系白血病（AML）异基因干细胞移植（SCT）的既定方法。MAC后大多数死亡发生在SCT后的前2年内，而无白血病存活2年的患者可预期良好的长期预后。然而，由于这种方法相对较新，关于RIC后的长期预后（超过10年）和晚期事件模式的数据较少。
方法
我们分析了1997 - 2005年间1423例年龄≥50岁、接受来自HLA匹配同胞的SCT的AML患者队列的长期预后，中位随访8.3年（0.1 - 17年）。
结果
MAC和RIC后10年无白血病生存率（LFS）分别为31%（95%CI，27 - 35）和32%（28 - 35）（P = 0.57）。作为生活质量替代指标的10年无移植物抗宿主病/无复发生存率（GRFS）分别为22%（18 - 25）和21%（18 - 24）（P = 0.79）。在整个移植后早期和晚期过程中，MAC后的10年非复发死亡率（NRM）较高，复发率较低。SCT后无白血病存活2年的584例患者中，MAC和RIC后的10年LFS分别为71%（65 - 76）和73%（67 - 78）（P = 0.76）。SCT时的晚期白血病是2年节点后LFS的主要预测因素。两种方案后复发都是晚期死亡的主要原因；然而，NRM，尤其是慢性移植物抗宿主病和第二肿瘤，是MAC后晚期死亡更常见的原因。
结论
RIC和MAC后的长期LFS和GRFS相似。RIC或MAC后的大多数事件发生在SCT后的前2年内。SCT后无白血病存活2年的患者在两种方法后均可预期相似的良好后续预后。
Zotero 插件