Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan.
Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
Biol Blood Marrow Transplant. 2019 Sep;25(9):1730-1743. doi: 10.1016/j.bbmt.2019.04.025. Epub 2019 May 2.
Although the prognosis of acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) is worse than that of AML not otherwise specified (AML-NOS), transplantation outcomes and prognosticators of AML-MRC patients undergoing allogeneic stem cell transplantation (allo-SCT) remain unclear. Transplantation outcomes of AML-MRC (n = 4091) were compared with those of AML-NOS (n = 3964) in patients who underwent allo-SCT between 2003 and 2016 using a nationwide registration database. The 3-year overall survival (OS; 35.5% versus 50.6%) was lower and the relapse (42.3% versus 32.1%) and nonrelapse mortality (26.3% versus 22.0%) rates were higher in the AML-MRC group than in the AML-NOS group. Based on the hierarchical AML-MRC classification, myelodysplasia as the sole criterion was associated with better OS compared with AML-NOS, whereas monosomal or complex karyotype and -5/del(5q) were associated with poor OS. A history of myelodysplastic syndrome and -7/del(7q) did not affect OS. Accordingly, AML-MRC with complex karyotype or -5/del(5q) and that with monosomal karyotype were classified as intermediate and high risks, respectively, whereas the remaining cases were classified as low risk. The 3-year OS rates were 50.7%, 36.9%, and 13.8% in the low-, intermediate-, and high-risk groups, respectively (P < .001). Risk classification, older age, and low performance status score were significant risk factors for survival in AML-MRC, independently of the disease status. Grades I to II acute graft-versus-host disease significantly reduced the 3-year relapse (24.7% versus 31.6%), leading to better survival (hazard ratio, .64). Our prognostic risk stratification can potentially aid in elucidating the diverse transplantation outcomes in patients with AML-MRC.
虽然伴有 MDS 相关改变的急性髓系白血病（AML-MRC）的预后比非特指性 AML（AML-NOS）差，但接受异基因造血干细胞移植（allo-SCT）的 AML-MRC 患者的移植结果和预后因素仍不清楚。使用全国注册数据库比较了 2003 年至 2016 年期间接受 allo-SCT 的 AML-MRC（n=4091）和 AML-NOS（n=3964）患者的移植结果。AML-MRC 组的 3 年总生存率（OS；35.5%对 50.6%）较低，复发率（42.3%对 32.1%）和非复发死亡率（26.3%对 22.0%）较高。基于分层 AML-MRC 分类，仅 MDS 作为标准与 AML-NOS 相比，OS 更好，而单倍体或复杂核型和-5/del(5q)与 OS 差相关。骨髓增生异常综合征病史和-7/del(7q)不影响 OS。因此，伴有复杂核型或-5/del(5q)和单倍体核型的 AML-MRC 分别被归类为中高危，而其余病例被归类为低危。低、中、高危组的 3 年 OS 率分别为 50.7%、36.9%和 13.8%（P<.001）。在 AML-MRC 中，风险分类、年龄较大和表现状态评分较低是生存的显著危险因素，与疾病状态无关。1 至 2 级急性移植物抗宿主病显著降低了 3 年的复发率（24.7%对 31.6%），从而提高了生存率（危险比，0.64）。我们的预后风险分层可能有助于阐明 AML-MRC 患者不同的移植结果。
