Shigematsu Akio, Kako Shinichi, Mitsuhashi Kenjiro, Iwato Koji, Uchida Naoyuki, Kanda Yoshinobu, Fukuda Takahiro, Sawa Masashi, Senoo Yasushi, Ogawa Hiroyasu, Miyamura Koichi, Takada Satoru, Nagamura-Inoue Tokiko, Morishima Yasuo, Ichinohe Tatsuo, Atsuta Yoshiko, Mizuta Shuichi, Tanaka Junji
Department of Hematology, Sapporo Hokuyu Hospital, Higashisapporo 6-6-5-1, Shiroishi-ku, Sapporo, Hokkaido, 003-0006, Japan.
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Int J Hematol. 2017 Jun;105(6):805-811. doi: 10.1007/s12185-017-2197-1. Epub 2017 Feb 14.
The prognosis for adult acute lymphoblastic leukemia (ALL) patients with central nervous system (CNS) involvement (CNS+) who received allogeneic hematopoietic stem cell transplantation (allo-SCT) remains unclear. We retrospectively compared the outcomes of allo-SCT for patients with CNS involvement and for patients without CNS involvement (CNS-) using a database in Japan. The eligibility criteria for this study were as follows: diagnosis of ALL, aged more than 16 years, allo-SCT between 2005 and 2012, and first SCT. Data for 2582 patients including 136 CNS+ patients and 2446 CNS- patients were used for analyses. As compared with CNS- patients, CNS+ patients were younger, had worse disease status at SCT and had poorer performance status (PS) at SCT (P < 0.01). Incidence of relapse was higher in CNS+ patients (P = 0.02), and incidence of CNS relapse was also higher (P < 0.01). The probability of 3-year overall survival (OS) was better in CNS- patients (P < 0.01) by univariate analysis. However, in patients who received SCT in CR, there was no difference in the probability of OS between CNS+ and CNS- patients (P = 0.38) and CNS involvement did not have an unfavorable effect on OS by multivariate analysis. CNS+ patients who achieved CR showed OS comparable to that of CNS- patients.
接受异基因造血干细胞移植（allo-SCT）的伴有中枢神经系统（CNS）受累（CNS+）的成人急性淋巴细胞白血病（ALL）患者的预后仍不明确。我们使用日本的一个数据库，回顾性比较了伴有CNS受累患者和不伴有CNS受累（CNS-）患者接受allo-SCT的结局。本研究的纳入标准如下：ALL诊断、年龄大于16岁、2005年至2012年间接受allo-SCT以及首次进行SCT。对2582例患者的数据进行分析，其中包括136例CNS+患者和2446例CNS-患者。与CNS-患者相比，CNS+患者年龄更小，SCT时疾病状态更差，SCT时体能状态（PS）更差（P<0.01）。CNS+患者的复发率更高（P=0.02），CNS复发率也更高（P<0.01）。单因素分析显示，CNS-患者的3年总生存率（OS）概率更好（P<0.01）。然而，在完全缓解（CR）期接受SCT的患者中，CNS+和CNS-患者的OS概率没有差异（P=0.38），多因素分析显示CNS受累对OS没有不利影响。达到CR的CNS+患者的OS与CNS-患者相当。
