Rina Zaizov Hematology-Oncology Division, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Rina Zaizov Hematology-Oncology Division, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
Biol Blood Marrow Transplant. 2018 Aug;24(8):1629-1642. doi: 10.1016/j.bbmt.2018.03.002. Epub 2018 Mar 13.
Outcome data were collected from the European Society for Blood and Marrow Transplantation registry on 373 children from 120 centers with relapsed leukemia (214 with acute lymphoblastic leukemia [ALL] and 159 with acute myelogenous leukemia [AML]) who underwent second allogeneic hematopoietic stem cell transplantation (HSCT) between 2004 and 2013. Overall survival (OS) was 38% at 2 years and 29% at 5 years, and leukemia-free survival (LFS) was 30% at 2 years and 25% at 5 years. Median follow-up after second HSCT was 36.4 months in the ALL group and 50.2 months in the AML group. In the ALL group, OS was 43% at 2 years and 33% at 5 years, and LFS was 34% at 2 years and 31% at 5 years. In the AML group, OS was 32% at 2 years and 24% at 5 years, and LFS was 24% at 2 years and 17% at 5 years. The 2-year nonrelapse mortality (NRM) rate was 22% in the ALL group and 18% in the AML group. Favorable prognostic factors (P < .05) for OS and LFS included >12 months between transplantations and chronic graft-versus-host disease after the first HSCT (in both groups), complete response before the second HSCT (ALL group only), and age >12 years (AML group only). Findings were more consistent over time in the ALL group, with no significant differences between 2-year and 5-year rates of relapse, NRM, and LFS. Children with relapsed acute leukemias have a substantial likelihood of long-term survival following second HSCT. Given the many novel targeted and immunomodulation therapies currently under development, it is important to identify specific patient subpopulations that may benefit from a second HSCT compared with those better suited to new approaches.
结果数据来自欧洲血液和骨髓移植学会的注册数据，涉及 120 个中心的 373 名复发白血病患儿（214 例急性淋巴细胞白血病[ALL]和 159 例急性髓细胞性白血病[AML]），他们在 2004 年至 2013 年间接受了第二次异基因造血干细胞移植（HSCT）。2 年和 5 年的总生存率（OS）分别为 38%和 29%，无白血病生存率（LFS）分别为 30%和 25%。第二次 HSCT 后中位随访时间在 ALL 组为 36.4 个月，AML 组为 50.2 个月。在 ALL 组中，2 年 OS 为 43%，5 年 OS 为 33%，2 年 LFS 为 34%，5 年 LFS 为 31%。在 AML 组中，2 年 OS 为 32%，5 年 OS 为 24%，2 年 LFS 为 24%，5 年 LFS 为 17%。ALL 组 2 年非复发死亡率（NRM）为 22%，AML 组为 18%。OS 和 LFS 的有利预后因素（P < .05）包括两次移植之间的间隔时间>12 个月和第一次 HSCT 后慢性移植物抗宿主病（两组）、第二次 HSCT 前完全缓解（仅 ALL 组）和年龄>12 岁（仅 AML 组）。ALL 组的结果随时间更为一致，2 年和 5 年的复发率、NRM 和 LFS 之间无显著差异。接受第二次 HSCT 后，复发急性白血病患儿有很大的长期生存机会。鉴于目前正在开发许多新的靶向和免疫调节治疗方法，重要的是要确定与新方法相比可能从第二次 HSCT 中受益的特定患者亚群。
