Jabbour Elias, Guastad Daver Naval, Short Nicholas James, Huang Xuelin, Chen Hsiang-Chun, Maiti Abhishek, Ravandi Farhad, Cortes Jorge, Abi Aad Simon, Garcia-Manero Guillermo, Estrov Zeev, Kadia Tapan, O'Brien Susan, Dabaja Bouthaina, Bueso-Ramos Carlos, Strati Paolo, Bivins Carol, Pierce Sherry, Kantarjian Hagop
Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030.
Departments of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030.
Am J Hematol. 2017 Sep;92(9):924-928. doi: 10.1002/ajh.24799. Epub 2017 Jul 19.
Central nervous system (CNS) relapse is uncommon in patients with acute myeloid leukemia (AML) with the use of high-dose cytarabine containing chemotherapy regimens. The clinical and molecular features associated with a higher risk of CNS relapse are not well defined. We assessed the incidence and outcome of CNS relapses among 1245 patients with relapsed/refractory AML referred to our institution between 2000 and 2014. CNS leukemia relapse was observed in 51 patients (4.1%). Using a multivariate regression model and after adjusting for age, FLT3-ITD mutation (OR = 2.33; P = .02) and elevated LDH (>1000 IU/L, OR = 1.99; P = .04) were independent predictive factors for CNS relapse. Patients under 64 years of age with 0, 1, or 2 baseline adverse features had a probability of 3.8%, 7.0%-8.0%, and 13.9% for developing CNS disease, respectively. Our study identifies patients with AML at higher risk for CNS relapse in whom prophylactic CNS therapy may be warranted.
在接受含大剂量阿糖胞苷化疗方案的急性髓系白血病（AML）患者中，中枢神经系统（CNS）复发并不常见。与CNS复发风险较高相关的临床和分子特征尚未明确界定。我们评估了2000年至2014年间转诊至我院的1245例复发/难治性AML患者中CNS复发的发生率和结局。51例患者（4.1%）出现CNS白血病复发。使用多变量回归模型并校正年龄后，FLT3-ITD突变（OR = 2.33；P = 0.02）和乳酸脱氢酶升高（>1000 IU/L，OR = 1.99；P = 0.04）是CNS复发的独立预测因素。64岁以下且具有0、1或2个基线不良特征的患者发生CNS疾病的概率分别为3.8%、7.0%-8.0%和13.9%。我们的研究确定了CNS复发风险较高的AML患者，这些患者可能需要进行预防性CNS治疗。
