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急性髓系白血病(AML)自体造血干细胞移植(AHSCT)的长期结局——单中心回顾性分析

Long-Term Outcome of Autologous Hematopoietic Stem Cell Transplantation (AHSCT) for Acute Myeloid Leukemia (AML)- Single Center Retrospective Analysis.

作者信息

Helbig Grzegorz, Koclęga Anna, Woźniczka Krzysztof, Kopera Małgorzata, Kyrcz-Krzemień Sławomira

机构信息

School of Medicine in Katowice, Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, Dąbrowski street 25, 40-032, Katowice, Poland.

出版信息

Pathol Oncol Res. 2018 Jul;24(3):469-475. doi: 10.1007/s12253-017-0266-7. Epub 2017 Jun 28.

Abstract

For patients with acute myeloid leukemia (AML) in complete remission without an acceptable HLA donor, the autologous hematopoietic stem cell transplantation (AHSCT) may remain a therapeutic option as remission consolidation, however its role is still a subject of continued debate. One hundred and twenty patients who underwent AHSCT for AML were included in this retrospective single center analysis. The procedure was performed over a 19 years period and transplanted patients were in first complete remission (CR1; n = 109) or in second CR (CR2; n = 11). The median age at transplant was 37 years (range 18-64). The source of stem cells was bone marrow (n = 61; 50.8%), peripheral blood (n = 36; 30%) and bone marrow with peripheral blood (n = 23; 19.2%). The median time from AML diagnosis to AHSCT was 0.8 year (range 0.3-4.4) and the median follow-up after AHSCT for surviving patients was 12.8 years (range 3.1-20.5). The median LFS was 1.1 year. The probability of LFS calculated at 5 years and 10 years after transplantation was 28% (95%CI, 22%-32%) and 21% (95%CI, 18%-24%), respectively. The last relapse occurred 14.8 years after AHSCT and among patients who survived >2 years, 28.4% (27/95) had leukemia recurrence. The median OS was 1.7 years. The probability of OS after 5 years and 10 years was 29% and 22%, respectively. There was a tendency for increased LFS for patients younger than 50 years at transplant if compared to older population. AHSCT for AML was safe with acceptable toxicity profile. Leukemia recurrence remained the leading cause of death.

摘要

对于急性髓系白血病(AML)完全缓解但没有合适人类白细胞抗原(HLA)供体的患者,自体造血干细胞移植(AHSCT)作为缓解巩固治疗可能仍是一种治疗选择,但其作用仍存在持续争议。本回顾性单中心分析纳入了120例行AHSCT治疗AML的患者。该手术在19年期间进行,移植患者处于首次完全缓解(CR1;n = 109)或第二次CR(CR2;n = 11)。移植时的中位年龄为37岁(范围18 - 64岁)。干细胞来源为骨髓(n = 61;50.8%)、外周血(n = 36;30%)和骨髓加外周血(n = 23;19.2%)。从AML诊断到AHSCT的中位时间为0.8年(范围0.3 - 4.4),存活患者AHSCT后的中位随访时间为12.8年(范围3.1 - 20.5)。中位无白血病生存期(LFS)为1.1年。移植后5年和10年计算的LFS概率分别为28%(95%CI,22% - 32%)和21%(95%CI,18% - 24%)。最后一次复发发生在AHSCT后14.8年,在存活超过2年的患者中,28.4%(27/95)有白血病复发。中位总生存期(OS)为1.7年。5年和10年后的OS概率分别为29%和22%。与老年人群相比,移植时年龄小于50岁的患者LFS有增加趋势。AML的AHSCT是安全的,毒性特征可接受。白血病复发仍然是主要死亡原因。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/00ad/5972158/84b0448a1957/12253_2017_266_Fig1_HTML.jpg

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