Tomizawa Daisuke, Tanaka Shiro, Kondo Tadakazu, Hashii Yoshiko, Arai Yasuyuki, Kudo Kazuko, Taga Takashi, Fukuda Takahiro, Goto Hiroaki, Inagaki Jiro, Koh Katsuyoshi, Ohashi Kazuteru, Ozawa Yukiyasu, Inoue Masami, Kato Koji, Tanaka Junji, Atsuta Yoshiko, Adachi Souichi, Ishida Hiroyuki
Division of Leukemia and Lymphoma, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan.
Department of Clinical Biostatistics, Kyoto University, Kyoto, Japan.
Biol Blood Marrow Transplant. 2017 Sep;23(9):1515-1522. doi: 10.1016/j.bbmt.2017.05.009. Epub 2017 May 10.
Few reports have focused on adolescent and young adult (AYA) patients with acute myeloid leukemia (AML) treated with hematopoietic stem cell transplantation (HSCT). We performed a retrospective analysis based on data obtained from a Japanese nationwide registration database to compare HSCT outcomes in AYA patients with AML with those in children with AML. An analysis of the 2973 patients with de novo AML who received allogeneic HSCT from 1990 to 2013 showed inferior 5-year overall survival (OS) (54% versus 58%, P <.01) and increased treatment-related mortality (TRM) (16% versus 13%, P = .02) in AYA patients. Multivariate analysis for both OS and TRM showed a significant negative impact on AYAs. However, the negative impact of older age lost its significance in an additional analysis focusing on 1407 recent transplant recipients with high-resolution HLA typing (2000 to 2013). Finally, we analyzed the impact of transplantation center type on HSCT outcomes in 317 adolescent patients (15 to 18 years old) and found no difference in outcomes between patients treated at a pediatric or an adult hospital. Higher age was a strong predictive factor for inferior OS resulting from increased TRM, which can be eliminated with better donor selection using high-resolution HLA typing.
很少有报告关注接受造血干细胞移植（HSCT）治疗的急性髓系白血病（AML）青少年和青年（AYA）患者。我们基于从日本全国注册数据库获得的数据进行了一项回顾性分析，以比较AML的AYA患者与AML儿童患者的HSCT结果。对1990年至2013年接受异基因HSCT的2973例初治AML患者的分析显示，AYA患者的5年总生存率（OS）较低（54%对58%，P＜0.01），治疗相关死亡率（TRM）增加（16%对13%，P = 0.02）。对OS和TRM的多因素分析显示对AYA患者有显著负面影响。然而，在针对1407例近期接受高分辨率HLA分型移植的受者（2000年至2013年）的另一项分析中，年龄较大的负面影响失去了显著性。最后，我们分析了移植中心类型对317例青少年患者（15至18岁）HSCT结果的影响，发现儿科医院或成人医院治疗的患者之间结果无差异。年龄较大是因TRM增加导致OS较差的一个强有力的预测因素，通过使用高分辨率HLA分型进行更好的供体选择可以消除这一因素。
