Ikegawa Shuntaro, Doki Noriko, Kaito Satoshi, Kurosawa Shuhei, Sakaguchi Masahiro, Harada Kaito, Yamamoto Keita, Hino Yutaro, Shingai Naoki, Senoo Yasushi, Watanabe Daisuke, Hagino Takeshi, Yoshioka Kosuke, Watakabe Kyoko, Igarashi Aiko, Najima Yuho, Kobayashi Takeshi, Kakihana Kazuhiko, Sakamaki Hisashi, Ohashi Kazuteru
Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
Pathol Oncol Res. 2017 Apr;23(2):433-437. doi: 10.1007/s12253-016-0162-6. Epub 2016 Dec 21.
Recent reports suggested that central nervous system (CNS) involvement (CNS+) in patients with acute myeloid leukemia (AML) before allogeneic hematopoietic stem cell transplantation (allo-HSCT) is not an independent predictor of survival after allo-HSCT. However, these studies did not analyze minimal residual disease in the CNS at the time of allo-HSCT. We evaluated the effect of residual CNS+ on the transplant outcomes of 214 AML patients in a single institution. Twenty-one (10%) patients were diagnosed with CNS+ prior to allo-HSCT. Of these, 13 patients had CNS disease at the time of allo-HSCT. The patients in CNS+ AML remission at the time of allo-HSCT had better overall survival (OS) than the patients who were not in remission (2-year OS: 55% vs. 7.7%, p = 0.0001). In multivariate analyses, CNS+ at the time of allo-HSCT (hazard ratio (HR), 1.9; 95% confidence interval (CI), 1.05-3.59; p = 0.04), age over 50 years at the time of allo-HSCT, and non-complete remission disease status in bone marrow at the time of allo-HSCT were independent adverse factors for OS. However, a prior history of CNS+ before allo-HSCT did not independently affect OS (HR, 1.27; 95% CI 0.53-2.07; p = 0.6). Early diagnosis and eradication of CNS+ at the time of allo-HSCT may be necessary to improve the outcome for patients with CNS+ AML.
近期报告显示，急性髓系白血病（AML）患者在异基因造血干细胞移植（allo-HSCT）前出现中枢神经系统（CNS）受累（CNS+）并非allo-HSCT后生存的独立预测因素。然而，这些研究并未分析allo-HSCT时CNS中的微小残留病。我们评估了残留CNS+对单中心214例AML患者移植结局的影响。21例（10%）患者在allo-HSCT前被诊断为CNS+。其中，13例患者在allo-HSCT时患有CNS疾病。allo-HSCT时处于CNS+ AML缓解期的患者总生存期（OS）优于未缓解的患者（2年OS：55%对7.7%，p = 0.0001）。在多变量分析中，allo-HSCT时的CNS+（风险比（HR），1.9；95%置信区间（CI），1.05 - 3.59；p = 0.04）、allo-HSCT时年龄超过50岁以及allo-HSCT时骨髓非完全缓解疾病状态是OS的独立不良因素。然而，allo-HSCT前CNS+的既往史并未独立影响OS（HR，1.27；95% CI 0.53 - 2.07；p = 0.6）。为改善CNS+ AML患者的结局，可能有必要在allo-HSCT时早期诊断并根除CNS+。
