Vanderbilt University Medical Center, Nashville, TN.
European Blood and Marrow Transplant Paris Study Office/CEREST-TC, Paris, France.
Blood Adv. 2018 Aug 28;2(16):2127-2135. doi: 10.1182/bloodadvances.2018019976.
Patients with secondary AML (sAML) with antecedent myelodysplastic syndrome (MDS) or myeloproliferative neoplasms (MPNs) tend to have high-risk disease based on the older age of patients, high-risk cytogenetics, and higher number of prior treatments. Allogeneic hematopoietic cell transplant (HCT) is the only potentially curative therapy available. Eight hundred and two adults with sAML and prior MDS/MPN who received a first HCT between 2000 and 2016 were included in the European Society for Blood and Marrow Transplant (EBMT) Acute Leukemia Working Party (ALWP) study. Median age of the cohort was 59.6 years (range, 18.6-78.6 years). Myeloablative conditioning (MAC) was given to 40% of patients, and 60% received reduced-intensity conditioning (RIC). Overall, the 2-year cumulative incidence of relapse (RI) was 37%, leukemia-free survival (LFS) was 40%, overall survival (OS) was 46%, nonrelapse mortality (NRM) was 23%, and chronic graft-versus-host disease (cGVHD) was 39%. In univariate analysis, a statistical difference between conditioning regimens 6 months after HCT in favor of the MAC group was noted with regard to RI (hazard ratio [HR], 1.47; = .03), LFS (HR, 1.43; = .01), and OS (HR, 1.55; < .05). There was no difference in the cumulative incidence of NRM (HR, 1.38; = .15). This effect was similarly seen in multivariate analysis (MVA): cumulative incidence of relapse (HR, 1.79; < .05), LFS (HR, 1.43; = .02), and OS (HR, 1.53; = .005) with no difference in NRM (HR, 1; = .98). This EBMT ALWP analysis suggests that long-term survival can be achieved in patients with sAML with antecedent MDS/MPN and that MAC is a suitable conditioning regimen in patients with sAML.
患有继发急性髓系白血病（sAML）且有先前骨髓增生异常综合征（MDS）或骨髓增殖性肿瘤（MPN）的患者通常具有高危疾病，基于患者年龄较大、高危细胞遗传学和更高的先前治疗次数。异基因造血细胞移植（HCT）是唯一可行的潜在治愈疗法。2000 年至 2016 年间，802 名患有 sAML 且有先前 MDS/MPN 的成年人在欧洲血液和骨髓移植学会（EBMT）急性白血病工作组（ALWP）研究中接受了首次 HCT。队列的中位年龄为 59.6 岁（范围，18.6-78.6 岁）。40%的患者接受了清髓性调理（MAC），60%的患者接受了强度降低的调理（RIC）。总体而言，2 年累积复发率（RI）为 37%，无白血病生存率（LFS）为 40%，总生存率（OS）为 46%，非复发死亡率（NRM）为 23%，慢性移植物抗宿主病（cGVHD）为 39%。在单变量分析中，在 HCT 后 6 个月，MAC 组在 RI（风险比[HR]，1.47；.03）、LFS（HR，1.43；.01）和 OS（HR，1.55； <.05）方面有统计学差异。在 NRM 的累积发生率方面没有差异（HR，1.38；.15）。在多变量分析（MVA）中也观察到了同样的效果：累积复发率（HR，1.79； <.05）、LFS（HR，1.43；.02）和 OS（HR，1.53；.005），NRM 无差异（HR，1； =.98）。这项 EBMT ALWP 分析表明，患有先前 MDS/MPN 的 sAML 患者可以实现长期生存，MAC 是 sAML 患者的合适调理方案。
