Department of Hematology and Cell Therapy and EBMT Paris Office, Hôpital Saint-Antoine APHP, INSERM U 938, Université Pierre et Marie Curie UPMC, Paris, France.
Department of Oncology, University Hospital Bern, 3010, Bern, Switzerland.
Am J Hematol. 2017 Dec;92(12):1318-1323. doi: 10.1002/ajh.24904. Epub 2017 Sep 28.
Patients with Acute Myelogenous Leukemia have a better outcome if reaching molecular remission. We compared the outcome of 373 patients autografted and 335 patients allografted with a 10/10 compatible unrelated donor in first molecular remission. Patients were stratified using the ELN European Leukemia Net classification. ELN favorable group: (234 auto and 70 unrelated transplants). By univariate analysis, in the auto group, the Non Relapse Mortality (NRM) was lower (3.7% versus 19%; P < 10 ), Relapse Incidence (RI) higher (29% versus 17%, P < 10 ), Leukemia Free Survival (LFS) identical (67% versus 64%) and Overall Survival (OS) better than in the allogeneic group (83% versus 62%; P = .008). By multivariate analysis, autologous transplantation was associated with a lower NRM (HR: 4, P = .01) and a better OS (HR: 2.08, P = .04). ELN intermediate group 1: (87 autologous and 172 unrelated transplants). By univariate analysis, in the auto group, NRM was lower (2.5% versus 11.8%; P = .03), RI higher (59% versus 18%, P < 10 ), LFS lower (39% versus 70%; P < 10 ) and OS lower than in the unrelated donor group (61% versus 74%; P = .005). By multivariate analysis, unrelated donor was superior to autologous transplantation for LFS (HR: 0.36, P < 10 and OS (HR: 0.53, P = .01). ELN intermediate group 2: (52 autologous and 93 unrelated donors). The outcome was identical. We conclude that good risk patients get higher benefit from autologous transplantation. Intermediate risk 2 patients have the same outcome and Intermediate risk 1 patients get higher benefit from unrelated donor transplants.
如果急性髓系白血病患者达到分子缓解，其预后会更好。我们比较了 373 例接受自体移植和 335 例接受 10/10 相容非亲缘供体异基因移植的处于首次分子缓解期患者的结果。患者使用欧洲白血病网（ELN）分类进行分层。ELN 预后良好组：（234 例自体和 70 例非亲缘移植）。单因素分析显示，在自体组中，非复发死亡率（NRM）较低（3.7%对 19%；P<0.01），复发率（RI）较高（29%对 17%；P<0.01），无白血病生存率（LFS）相同（67%对 64%），总生存率（OS）优于异基因组（83%对 62%；P=0.008）。多因素分析显示，自体移植与较低的 NRM 相关（HR：4，P=0.01）和更好的 OS（HR：2.08，P=0.04）。ELN 中危 1 组：（87 例自体和 172 例非亲缘移植）。单因素分析显示，在自体组中，NRM 较低（2.5%对 11.8%；P=0.03），RI 较高（59%对 18%；P<0.01），LFS 较低（39%对 70%；P<0.01），OS 低于非亲缘供体组（61%对 74%；P=0.005）。多因素分析显示，非亲缘供体在 LFS（HR：0.36，P<0.01）和 OS（HR：0.53，P=0.01）方面优于自体移植。ELN 中危 2 组：（52 例自体和 93 例非亲缘供体）。结果相同。我们得出结论，低危患者从自体移植中获益更高。中危 2 组患者的结果相同，而中危 1 组患者从非亲缘供体移植中获益更高。
