Department of Hematology and Oncology, Klinikum Augsburg, University of Munich, Augsburg, Germany
Department of Medical Statistics & Bioinformatics, Leiden University Medical Center, the Netherlands.
Haematologica. 2018 Feb;103(2):237-245. doi: 10.3324/haematol.2017.168716. Epub 2017 Nov 3.
No standard exists for the treatment of myelodysplastic syndrome relapsing after allogeneic stem cell transplantation. We performed a retrospective registry analysis of outcomes and risk factors in 698 patients, treated with different strategies. The median overall survival from relapse was 4.7 months (95% confidence interval: 4.1-5.3) and the 2-year survival rate was 17.7% (95% confidence interval: 14.8-21.2%). Shorter remission after transplantation (<0.001), advanced disease (=0.001), older age (=0.007), unrelated donor (=0.008) and acute graft--host disease before relapse (<0.001) adversely influenced survival. At 6 months from relapse, patients had received no cellular treatment, (i.e. palliative chemotherapy or best supportive care, n=375), donor lymphocyte infusion (n=213), or a second transplant (n=110). Treatment groups were analyzed separately because of imbalanced characteristics and difficulties in retrospectively evaluating the reason for individual treatments. Of the patients who did not receive any cellular therapy, 109 were alive at 6 months after relapse, achieving a median overall survival from this landmark of 8.9 months (95% confidence interval: 5.1-12.6). Their 2-year survival rate was 29.7%. Recipients of donor lymphocytes achieved a median survival from first infusion of 6.0 months (95% confidence interval: 3.7-8.3) with a 2-year survival rate of 27.6%. Longer remission after first transplantation (<0.001) and younger age (=0.009) predicted better outcome. Among recipients of a second transplant, the median survival from second transplantation was 4.2 months (95% confidence interval: 2.5-5.9), and their 2-year survival rate was 17.0%. Longer remission after first transplantation (<0.001), complete remission at second transplant (=0.008), no prior chronic graft--host disease (<0.001) and change to a new donor (=0.04) predicted better outcome. The data enabled identification of patients benefiting from donor lymphocyte infusion and second transplantation, and may serve as a baseline for prospective trials.
对于异基因造血干细胞移植后复发的骨髓增生异常综合征，目前尚无标准的治疗方法。我们对 698 例采用不同策略治疗的患者进行了回顾性登记分析，以评估其结局和危险因素。从复发到死亡的中位总生存期为 4.7 个月（95%置信区间：4.1-5.3），2 年生存率为 17.7%（95%置信区间：14.8-21.2%）。移植后缓解期较短（<0.001）、疾病进展（=0.001）、年龄较大（=0.007）、无关供者（=0.008）和复发前急性移植物抗宿主病（<0.001）均对生存不利。在复发后 6 个月时，患者未接受任何细胞治疗（即姑息性化疗或最佳支持治疗，n=375）、供者淋巴细胞输注（n=213）或二次移植（n=110）。由于特征不平衡以及难以回顾性评估个体治疗的原因，因此对治疗组进行了单独分析。在未接受任何细胞治疗的患者中，有 109 例在复发后 6 个月时存活，由此达到的从该时间点起的中位总生存期为 8.9 个月（95%置信区间：5.1-12.6），其 2 年生存率为 29.7%。接受供者淋巴细胞输注的患者的首次输注后中位生存期为 6.0 个月（95%置信区间：3.7-8.3），2 年生存率为 27.6%。首次移植后缓解期较长（<0.001）和年龄较小（=0.009）预示着更好的结局。在接受二次移植的患者中，从二次移植起的中位生存期为 4.2 个月（95%置信区间：2.5-5.9），2 年生存率为 17.0%。首次移植后缓解期较长（<0.001）、二次移植时达到完全缓解（=0.008）、无既往慢性移植物抗宿主病（<0.001）和更换供者（=0.04）预示着更好的结局。这些数据确定了从供者淋巴细胞输注和二次移植中获益的患者，并可为前瞻性试验提供基线数据。
