Dept. of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, Gliwice, Poland.
Acute Leukemia Working Party of the EBMT, Paris, France; Dept. of Hematology, Hôpital Saint-Antoine, Paris, France.
Eur J Cancer. 2018 Jun;96:73-81. doi: 10.1016/j.ejca.2018.03.018. Epub 2018 Apr 18.
Allogeneic haematopoietic stem cell transplantation (alloHSCT) is considered a standard treatment for patients with Philadelphia chromosome-positive acute lymphoblastic leukaemia (Ph+ ALL) achieving complete remission after induction containing tyrosine kinase inhibitors (TKIs).
We retrospectively compared results of myeloablative alloHSCT from either matched sibling donor (MSD) or unrelated donor (URD) with autologous (auto) HSCT for adults with Ph+ ALL in molecular remission, treated between 2007 and 2014.
In univariate analysis, the incidence of relapse at 2 years was 47% after autoHSCT, 28% after MSD-HSCT and 19% after URD-HSCT (P = 0.0002). Respective rates of non-relapse mortality were 2%, 18%, and 22% (P = 0.001). The probabilities of leukaemia-free survival were 52%, 55% and 60% (P = 0.69), while overall survival rates were 70%, 70% and 69% (P = 0.58), respectively. In multivariate analysis, there was a trend towards increased risk of overall mortality after MSD-HSCT (hazard ratio [HR], 1.5, P = 0.12) and URD-HSCT (HR, 1.6, P = 0.08) when referred to autoHSCT. The use of total body irradiation (TBI)-based regimens was associated with reduced risk of relapse (HR, 0.65, P = 0.02) and overall mortality (HR, 0.67, P = 0.01).
In the era of TKIs, outcomes of myeloablative autoHSCT and alloHSCT for patients with Ph+ ALL in first molecular remission are comparable. Therefore, autoHSCT appears to be an attractive treatment option potentially allowing for circumvention of alloHSCT sequelae. Irrespective of the type of donor, TBI-based regimens should be considered the preferable type of conditioning for Ph+ ALL.
异体造血干细胞移植（alloHSCT）被认为是诱导缓解治疗后达到完全缓解的费城染色体阳性急性淋巴细胞白血病（Ph+ ALL）患者的标准治疗方法，该缓解治疗方案中包含了酪氨酸激酶抑制剂（TKIs）。
我们回顾性比较了 2007 年至 2014 年间处于分子缓解期的成人 Ph+ ALL 患者接受同种异体（MSD 或 URD）造血干细胞移植或自体造血干细胞移植（autoHSCT）的结果。
在单因素分析中，autoHSCT 后 2 年的复发率为 47%，MSD-HSCT 后为 28%，URD-HSCT 后为 19%（P=0.0002）。相应的非复发死亡率分别为 2%、18%和 22%（P=0.001）。无白血病生存率分别为 52%、55%和 60%（P=0.69），总生存率分别为 70%、70%和 69%（P=0.58）。多因素分析显示，与 autoHSCT 相比，MSD-HSCT（风险比 [HR]，1.5，P=0.12）和 URD-HSCT（HR，1.6，P=0.08）后整体死亡率有增加的趋势。全身照射（TBI）为基础的方案与降低复发率（HR，0.65，P=0.02）和整体死亡率（HR，0.67，P=0.01）相关。
在 TKI 时代，Ph+ ALL 患者在首次分子缓解时进行清髓性自体造血干细胞移植和异体造血干细胞移植的结果相当。因此，自体造血干细胞移植似乎是一种有吸引力的治疗选择，有可能避免异体造血干细胞移植的并发症。无论供体类型如何，基于 TBI 的方案都应被认为是 Ph+ ALL 患者首选的预处理方案。
