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采用自体干细胞移植巩固治疗具有有利风险的急性髓系白血病患者的预后较好。

Superior outcome of patients with favorable-risk acute myeloid leukemia using consolidation with autologous stem cell transplantation.

机构信息

Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus , Haifa , Israel.

Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel.

出版信息

Leuk Lymphoma. 2019 Oct;60(10):2449-2456. doi: 10.1080/10428194.2019.1594214. Epub 2019 Apr 3.

Abstract

Autologous stem cell transplantation (ASCT), intensifying anti-leukemic effects without significant treatment-related mortality (TRM), is particularly appealing in AML with favorable genetic/molecular profile. This study retrospectively evaluated the outcomes of post-remission treatment in consecutive favorable-risk AML patients. Sixty-six patients were included: 32 had mutated NPM1/wild-type FLT-ITD, 16 had t(8:21) and 18 - inv(16). Forty patients received chemotherapy alone, 26 underwent ASCT upfront. In time-dependent analysis, the ASCT group demonstrated higher relapse-free (RFS) ( = .001) and overall survivals (OS) ( = .0007). The 1-year RFS and OS were 44.2% vs 88% and 71% vs 96% for chemotherapy and ASCT, respectively. The corresponding TRM was 4/40 (10.0%) and 0/26 (0%), with relapse rates of 70.0% and 19.2% ( = .0002). In multivariate analysis, ASCT was associated with superior OS and RFS. In conclusion, ASCT offers significantly superior RFS and OS in favorable-risk AML in first complete remission. These data support the recent resurgence of interest in ASCT for AML.

摘要

自体干细胞移植(ASCT)可增强抗白血病效果,且无明显治疗相关死亡率(TRM),尤其适用于具有良好遗传/分子特征的 AML。本研究回顾性评估了连续低危 AML 患者缓解后治疗的结果。共纳入 66 例患者:32 例存在 NPM1 突变/野生型 FLT-ITD,16 例存在 t(8:21),18 例存在 inv(16)。40 例患者接受单纯化疗,26 例患者行 ASCT 作为一线治疗。在时间依赖性分析中,ASCT 组的无复发生存(RFS)(= 0.001)和总生存(OS)(= 0.0007)更高。化疗组和 ASCT 组的 1 年 RFS 和 OS 分别为 44.2%和 88%、71%和 96%。相应的 TRM 为 4/40(10.0%)和 0/26(0%),复发率为 70.0%和 19.2%(= 0.0002)。多因素分析显示,ASCT 与更好的 OS 和 RFS 相关。总之,ASCT 可显著改善首次完全缓解后低危 AML 的 RFS 和 OS。这些数据支持了最近 ASCT 在 AML 中再次受到关注的趋势。

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