Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Clin Lymphoma Myeloma Leuk. 2018 Apr;18(4):e167-e182. doi: 10.1016/j.clml.2018.02.009. Epub 2018 Feb 17.
To identify factors affecting survival outcomes and to develop a prognostic model for second allogeneic stem-cell transplantation (allo-SCT2) for relapsed acute myeloid leukemia (AML) after the first autologous or allogeneic stem-cell transplantation.
Seventy-eight consecutive adult AML patients who received allo-SCT2 were analyzed in this retrospective study.
The 4-year overall survival (OS) rate was 28.7%. In multivariate analysis, poor cytogenetic risk at diagnosis, circulating blast ≥ 20% at relapse, duration from first transplantation to relapse < 9 months, and failure to achieve morphologic complete remission after allo-SCT2 were factors associated with poor OS. A prognostic model was developed with the following score system: intermediate and poor cytogenetic risk at diagnosis (0.5 and 1 point), peripheral blast ≥ 20% at relapse (1 point), duration from the first transplantation to relapse < 9 months (1 point), and failure to achieve morphologic complete remission after allo-SCT2 (1 point). The model identified 2 subgroups according to the 4-year OS rate: 51.3% in the low-risk group (score < 2) and 2.8% in the high-risk group (score ≥ 2) (P < .001).
This prognostic model might be useful to make an appropriate decision for allo-SCT2 in relapsed AML after the first autologous or allogeneic stem-cell transplantation.
确定影响生存结果的因素，并为首次自体或异体干细胞移植后复发的急性髓系白血病（AML）患者建立二次异基因干细胞移植（allo-SCT2）的预后模型。
本回顾性研究分析了 78 例连续接受 allo-SCT2 的成年 AML 患者。
4 年总生存率（OS）为 28.7%。多因素分析显示，诊断时不良细胞遗传学风险、复发时循环 blast≥20%、首次移植至复发的时间<9 个月、allo-SCT2 后未达到形态学完全缓解是与 OS 不良相关的因素。建立了一个预后模型，评分系统如下：诊断时的中危和高危细胞遗传学风险（0.5 分和 1 分）、复发时外周 blast≥20%（1 分）、首次移植至复发的时间<9 个月（1 分）、allo-SCT2 后未达到形态学完全缓解（1 分）。该模型根据 4 年 OS 率将患者分为 2 个亚组：低危组（评分<2）为 51.3%，高危组（评分≥2）为 2.8%（P<0.001）。
该预后模型可能有助于为首次自体或异体干细胞移植后复发的 AML 患者做出 allo-SCT2 的适当决策。
