Section of Hematology & Medical Oncology, Tulane University, New Orleans, LA, USA
Hôpital Saint Antoine, Paris, France.
Haematologica. 2017 Dec;102(12):2134-2140. doi: 10.3324/haematol.2017.174441. Epub 2017 Sep 29.
Mixed phenotype acute leukemias are infrequent and considered high risk. The optimal treatment approach and the role of allogeneic hematopoietic stem cell transplantation are not entirely clear. In this study, we investigated 519 patients with mixed phenotype acute leukemia in first complete remission who underwent allogeneic hematopoietic stem cell transplantation between 2000 and 2014, and who were reported to the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT). Median age was 38.1 years (range 18-75). Cytogenetics classified 49.3% as poor risk. At three years, relapse incidence was 31.4% (26.9-35.9), non-relapse mortality was 22.1% (18.4-26.1), the leukemia-free survival was 46.5% (41.7-51.4), and the overall survival was 56.3% (51.5-61.2). At six months, 32.5% had developed acute graft--host disease, while at three years, 37.5% had developed chronic graft--host disease (32.6-42.3). In a multivariate analysis, age and year of transplant had a strong impact on outcome. Myeloablative conditioning using total body irradiation correlated with a better leukemia-free survival. Our study suggests that mixed phenotype acute leukemia is potentially sensitive to graft--leukemia and thus can benefit from allogeneic hematopoietic stem cell transplantation with a potential for cure.
混合表型急性白血病较为罕见，被认为是高危疾病。目前尚不完全清楚其最佳治疗方法和异基因造血干细胞移植的作用。在这项研究中，我们调查了 2000 年至 2014 年间在欧洲血液和骨髓移植学会（EBMT）急性白血病工作组登记接受异基因造血干细胞移植且处于首次完全缓解的 519 例混合表型急性白血病患者。中位年龄为 38.1 岁（范围 18-75）。细胞遗传学将 49.3%的患者分类为不良风险。3 年时，复发率为 31.4%（26.9-35.9），非复发死亡率为 22.1%（18.4-26.1），无白血病生存率为 46.5%（41.7-51.4），总生存率为 56.3%（51.5-61.2）。6 个月时，32.5%的患者发生急性移植物抗宿主病，3 年后，37.5%的患者发生慢性移植物抗宿主病（32.6-42.3）。多变量分析显示，年龄和移植年份对结果有很强的影响。使用全身照射的清髓性预处理与更好的无白血病生存率相关。我们的研究表明，混合表型急性白血病可能对移植物抗白血病敏感，因此可从异基因造血干细胞移植中受益，有治愈的可能。
