Department of Haematology, Leeds Teaching Hospitals Trust, Leeds, UK.
EBMT Paris study office/CEREST-TC, Paris, France.
Leukemia. 2020 Jan;34(1):87-99. doi: 10.1038/s41375-019-0527-4. Epub 2019 Jul 30.
Allogeneic haemopoietic cell transplant (allo-HCT) may be curative in acute myeloid leukaemia (AML) in second complete remission (CR2) but the impact of reduced intensity (RIC) versus myeloablative conditioning (MAC) is uncertain. The Acute Leukaemia Working Party of the European Society for Blood and Bone Marrow Transplantation Registry studied an AML CR2 cohort characterised by age ≥ 18 years, first allo-HCT 2007-2016, available cytogenetic profile at diagnosis, donors who were matched family, volunteer unrelated with HLA antigen match 10/10 or 9/10 or haplo-identical. The 1879 eligible patients included 1010 (54%) MAC allo-HCT recipients. In patients <50 years (y), two year outcomes for MAC vs RIC allo-HCT were equivalent with leukaemia-free survival (LFS) 54% for each, overall survival (OS), 61% vs 62%, non-relapse mortality (NRM) 18% vs 15% and graft versus host disease relapse-free survival (GRFS) 38% vs 42%. In patients ≥50 y, 2 y outcomes for MAC vs RIC allo-HCT were equivalent for LFS 52% vs 49%, OS 58% vs 55% and GRFS 42.4% vs 36%. However, NRM was significantly inferior after MAC allo-HCT, 27% vs 19% (P = 0.01) despite worse cGVHD after RIC-allo (32% vs 39%). These data support the need for ongoing prospective study of conditioning intensity and GVHD mitigation in AML.
异基因造血细胞移植（allo-HCT）可能对第二次完全缓解（CR2）的急性髓系白血病（AML）有治愈作用，但强度降低（RIC）与清髓性预处理（MAC）的影响尚不确定。欧洲血液和骨髓移植学会急性白血病工作组的注册研究纳入了一个 AML CR2 队列，该队列的特征为年龄≥18 岁、首次 allo-HCT 在 2007-2016 年、在诊断时具有可获得的细胞遗传学特征、供者为匹配的家族供者、HLA 抗原匹配 10/10 或 9/10 的志愿无关供者或半相合供者。符合条件的 1879 例患者中包括 1010 例 MAC allo-HCT 受者。在年龄<50 岁的患者中，MAC 与 RIC allo-HCT 的 2 年结果相当，白血病无复发生存率（LFS）分别为 54%和 54%，总生存率（OS）分别为 61%和 62%，非复发死亡率（NRM）分别为 18%和 15%，移植物抗宿主病无复发存活率（GRFS）分别为 38%和 42%。在年龄≥50 岁的患者中，MAC 与 RIC allo-HCT 的 2 年结果相当，LFS 分别为 52%和 49%，OS 分别为 58%和 55%，GRFS 分别为 42.4%和 36%。然而，MAC allo-HCT 后 NRM 显著更差，为 27%比 19%（P=0.01），尽管 RIC-allo 后 cGVHD 更严重（32%比 39%）。这些数据支持在 AML 中对预处理强度和移植物抗宿主病缓解进行持续的前瞻性研究的必要性。
