白血病在未经处理的单倍体相合移植后复发：EBMT 的 ALWP 代表的风险因素分析。
Leukemia relapse following unmanipulated haploidentical transplantation: a risk factor analysis on behalf of the ALWP of the EBMT.
机构信息
Hematology and Bone Marrow Transplant Unit, San Raffaele Scientific Institute, Milan, Italy.
Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.
出版信息
J Hematol Oncol. 2019 Jul 4;12(1):68. doi: 10.1186/s13045-019-0751-4.
BACKGROUND
As information on incidence, risk factors, and outcome of acute leukemia (AL) relapse after unmanipulated haploidentical stem cell transplantation (haplo-SCT) is scarce, a retrospective registry study was performed by the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation.
METHODS
Among 1652 transplants performed for lymphoblastic and myeloid AL between 2007 and 2014, 587 patients (acute lymphoblastic leukemia (ALL) 131, acute myeloid leukemia (AML) 456) with detailed information were analyzed aiming to identify risk factors for post-transplant relapse and for overall survival (OS) after relapse.
RESULTS
The cumulative incidence of relapse at 3 years was 44% (35-53%) for ALL and 32% (27-36%) for AML (p = 0.023). In ALL, risk factors for relapse were disease status different from the first complete remission (CR1) at haplo-SCT (CR2 vs CR1: HR 2.85, p = 0.011; advanced vs CR1: HR 14.28, p < 0.0001) and male donor gender (HR 3.64, p = 0.0002), while in AML, risk factors were advanced disease at haplo-SCT (advanced vs CR1: HR 3.95, p < 0.0001) and comorbidities (HCT-CI) ≥ 3 (HR 1.75, p = 0.014). Transplants performed in more recent years were associated with lower relapse incidence (RI) in AML, but not in ALL (HR 0.91, p = 0.042). After relapse, median follow-up was 13 months (mos). OS at 1-year post relapse was 18%. Prognostic factors for superior OS after relapse were remission at time of haplo-SCT (CR vs advanced: HR 0.71, p = 0.028), time from transplant to relapse (≥ 5 mos vs < 5 mos: HR 0.530, p < 0.0001), and bone marrow as a stem cell source (peripheral blood (PB) vs bone marrow (BM): HR 1.473, p = 0.016).
CONCLUSIONS
Risk factors for relapse after haploidentical transplantation were disease specific. Longer OS after relapse was achieved in particular by patients both in CR at haplo-SCT and relapsing more than 5 months after transplant (1-year OS 33%).
背景
由于关于未经处理的单倍体相合造血干细胞移植（haplo-SCT）后急性白血病（AL）复发的发病率、风险因素和结果的信息很少，因此欧洲血液和骨髓移植学会的急性白血病工作组进行了一项回顾性登记研究。
方法
在 2007 年至 2014 年间进行的 1652 例淋巴母细胞和髓性 AL 移植中，对 587 例（急性淋巴细胞白血病（ALL）131 例，急性髓性白血病（AML）456 例）有详细信息的患者进行了分析，旨在确定移植后复发和复发后总生存（OS）的风险因素。
结果
ALL 患者的 3 年复发累积发生率为 44%（35-53%），AML 患者为 32%（27-36%）（p=0.023）。在 ALL 中，复发的危险因素是 haplo-SCT 时疾病状态与首次完全缓解（CR1）不同（CR2 与 CR1：HR 2.85，p=0.011；晚期与 CR1：HR 14.28，p<0.0001）和供者为男性（HR 3.64，p=0.0002），而在 AML 中，危险因素是 haplo-SCT 时疾病晚期（晚期与 CR1：HR 3.95，p<0.0001）和合并症（HCT-CI）≥3（HR 1.75，p=0.014）。最近几年进行的移植与 AML 复发的复发发生率较低相关，但与 ALL 无关（HR 0.91，p=0.042）。在复发后，中位随访时间为 13 个月（mos）。复发后 1 年的 OS 为 18%。复发后 OS 更好的预后因素是 haplo-SCT 时缓解（CR 与晚期：HR 0.71，p=0.028）、移植至复发的时间（≥5 mos 与 <5 mos：HR 0.530，p<0.0001）以及骨髓作为干细胞来源（外周血（PB）与骨髓（BM）：HR 1.473，p=0.016）。
结论
haplo-SCT 后复发的危险因素是疾病特异性的。特别是在 haplo-SCT 时处于 CR 且在移植后 5 个月以上复发的患者（1 年 OS 为 33%）中，可实现更长的复发后 OS。
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