细胞遗传学风险决定第二次完全缓解的老年急性髓系白血病患者异基因移植后的结局：国际血液和骨髓移植研究中心队列分析
Cytogenetic risk determines outcomes after allogeneic transplantation in older patients with acute myeloid leukemia in their second complete remission: A Center for International Blood and Marrow Transplant Research cohort analysis.
作者信息
Michelis Fotios V, Gupta Vikas, Zhang Mei-Jie, Wang Hai-Lin, Aljurf Mahmoud, Bacher Ulrike, Beitinjaneh Amer, Chen Yi-Bin, DeFilipp Zachariah, Gale Robert Peter, Kebriaei Partow, Kharfan-Dabaja Mohamed, Lazarus Hillard M, Nishihori Taiga, Olsson Richard F, Oran Betul, Rashidi Armin, Rizzieri David A, Tallman Martin S, de Lima Marcos, Khoury H Jean, Sandmaier Brenda M, Weisdorf Daniel, Saber Wael
机构信息
Allogeneic Blood and Marrow Transplant Program, Princes Margaret Cancer Centre, Toronto, Ontario, Canada.
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
出版信息
Cancer. 2017 Jun 1;123(11):2035-2042. doi: 10.1002/cncr.30567. Epub 2017 Jan 24.
BACKGROUND
Allogeneic hematopoietic cell transplantation (HCT) offers curative potential to a number of older patients with acute myeloid leukemia (AML) in their first complete remission. However, there are limited data in the literature concerning post-HCT outcomes for older patients in their second complete remission (CR2).
METHODS
The purpose of the current study was to retrospectively investigate within the Center for International Blood and Marrow Transplant Research database parameters influencing posttransplant outcomes for patients 60 years of age or older undergoing HCT for AML in CR2.
RESULTS
In total, 196 patients from 78 centers were identified; the median age was 64 years (range, 60-78 years). Seventy-one percent had a Karnofsky performance status ≥ 90 at the time of HCT. Reduced-intensity conditioning regimens were used in 159 patients (81%). A univariate analysis demonstrated a 3-year overall survival (OS) rate of 42% (95% confidence interval [CI], 35%-49%), a leukemia-free survival rate of 37% (95% CI, 30%-44%), a cumulative incidence of nonrelapse mortality of 25% (95% CI, 19%-32%), and a cumulative incidence of relapse (CIR) of 38% (95% CI, 31%-45%). A multivariate analysis demonstrated that cytogenetic risk was the only independent risk factor for OS (P = .023) with a hazard ratio (HR) of 1.14 (95% CI, 0.59-2.19) for intermediate-risk cytogenetics and an HR of 2.32 (95% CI, 1.05-5.14) for unfavorable-risk cytogenetics. For CIR, cytogenetic risk was also the only independent prognostic factor (P = .01) with an HR of 1.10 (95% CI, 0.47-2.56) for intermediate-risk cytogenetics and an HR of 2.98 (95% CI, 1.11-8.00) for unfavorable-risk cytogenetics.
CONCLUSIONS
Allogeneic HCT is a curative treatment option for older patients with AML in CR2, particularly for those with favorable or intermediate cytogenetic risk. Cancer 2017;123:2035-2042. © 2017 American Cancer Society.
背景
异基因造血细胞移植（HCT）为许多首次完全缓解的老年急性髓系白血病（AML）患者提供了治愈的可能。然而，关于老年患者第二次完全缓解（CR2）后HCT结局的文献数据有限。
方法
本研究的目的是在国际血液和骨髓移植研究中心数据库中，回顾性调查影响60岁及以上AML患者在CR2期接受HCT后移植结局的参数。
结果
共识别出78个中心的196例患者；中位年龄为64岁（范围60 - 78岁）。71%的患者在HCT时卡氏评分≥90。159例患者（81%）采用了减低强度预处理方案。单因素分析显示3年总生存率（OS）为42%（95%置信区间[CI]，35% - 49%），无白血病生存率为37%（95% CI，30% - 44%），非复发死亡率累积发生率为25%（95% CI，19% - 32%），复发累积发生率（CIR）为38%（95% CI，31% - 45%）。多因素分析显示，细胞遗传学风险是OS的唯一独立危险因素（P = 0.023），中危细胞遗传学的风险比（HR）为1.14（95% CI，0.59 - 2.19），高危细胞遗传学的HR为2.32（95% CI，1.05 - 5.14）。对于CIR，细胞遗传学风险也是唯一的独立预后因素（P = 0.01），中危细胞遗传学的HR为1.10（95% CI，0.47 - 2.56），高危细胞遗传学的HR为2.98（95% CI，1.11 - 8.00）。
结论
异基因HCT是CR2期老年AML患者的一种治愈性治疗选择，特别是对于那些细胞遗传学风险良好或中等的患者。《癌症》2017年；123：2035 - 2042。© 2017美国癌症协会。
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