Vydra Jan, Šálek Cyril, Schwarz Jiří, Žák Pavel, Novák Jan, Petečuková Veronika, Pecherková Pavla, Mayer Jiří, Cetkovský Petr, Ráčil Zdeněk
Institute of Hematology and Blood Transfusion, Prague, Czech Republic; Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic.
Institute of Hematology and Blood Transfusion, Prague, Czech Republic.
Clin Lymphoma Myeloma Leuk. 2018 Feb;18(2):106-113. doi: 10.1016/j.clml.2017.11.011. Epub 2017 Dec 7.
We retrospectively analyzed data from 310 patients with acute myeloid leukemia with intermediate-risk cytogenetics in first complete remission (CR1) to evaluate the usage and efficacy of various types of postremission therapy.
Cox regression with time-dependent covariates, landmark analysis, and competing risk models were used to estimate the outcomes and effects of treatment and patient- and disease-related risk factors.
The early relapse rate and early nonrelapse mortality (NRM) were 12.8% and 4.4%, respectively. In our study, 77.2% of patients completed postremission therapy: 44% received allogeneic hematopoietic cell transplantation (HCT), 20% completed treatment with high-dose cytarabine (HIDAC), and 13% completed treatment with intermediate-dose cytarabine. The 3-year overall survival rate was 67.5% for patients treated with HIDAC and 63.4% after HCT (P = .5876). The NRM and relapse rate at 3 years were 0% and 58.9% after HIDAC and 21.9% and 29.3% after HCT, respectively. HCT reduced the risk of relapse (hazard ratio, 0.6; 95% confidence interval, 0.36-0.98). Total body irradiation-based myeloablative conditioning increased NRM compared with busulfan-based conditioning (hazard ratio, 8.33; 95% confidence interval, 2.52-27.45).
Most patients with acute myeloid leukemia with intermediate-risk cytogenetics received allogeneic HCT, which decreased the risk of relapse but increased NRM, leading to a similar overall survival for patients who received HCT and HIDAC. Our data support the use of allogeneic transplantation for patients in CR1 from a human leukocyte antigen-matched related or unrelated donor after a busulfan-based myeloablative conditioning regimen as a primary strategy of postremission therapy for eligible younger patients.
我们回顾性分析了310例处于首次完全缓解（CR1）期且具有中危细胞遗传学特征的急性髓系白血病患者的数据，以评估各种缓解后治疗的使用情况和疗效。
采用带有时间依赖性协变量的Cox回归、标志性分析和竞争风险模型来估计治疗结果和效应以及患者和疾病相关的风险因素。
早期复发率和早期非复发死亡率分别为12.8%和4.4%。在我们的研究中，77.2%的患者完成了缓解后治疗：44%接受了异基因造血细胞移植（HCT），20%完成了大剂量阿糖胞苷（HIDAC）治疗，13%完成了中剂量阿糖胞苷治疗。接受HIDAC治疗的患者3年总生存率为67.5%，HCT治疗后为63.4%（P = 0.5876）。HIDAC治疗后3年的非复发死亡率和复发率分别为0%和58.9%，HCT治疗后分别为21.9%和29.3%。HCT降低了复发风险（风险比，0.6；95%置信区间，0.36 - 0.98）。与白消安预处理相比，基于全身照射的清髓性预处理增加了非复发死亡率（风险比，8.33；95%置信区间，2.52 - 27.45）。
大多数具有中危细胞遗传学特征的急性髓系白血病患者接受了异基因HCT，这降低了复发风险，但增加了非复发死亡率，导致接受HCT和HIDAC治疗的患者总生存率相似。我们的数据支持在白消安预处理方案后，将来自人类白细胞抗原匹配的相关或无关供体的异基因移植作为符合条件的年轻患者缓解后治疗的主要策略，用于CR1期患者。
