Ho Vincent T, Martin Andrew St, Pérez Waleska S, Steinert Patricia, Zhang Mei-Jie, Chirnomas Deborah, Hoang Caroline J, Loberiza Fausto R, Saber Wael
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Biol Blood Marrow Transplant. 2020 May;26(5):884-892. doi: 10.1016/j.bbmt.2019.12.763. Epub 2019 Dec 28.
Gemtuzumab ozogamicin (GO) therapy before allogeneic hematopoietic cell transplantation (alloHCT) has been historically associated with an increased risk of hepatic veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) in patients with acute myeloid leukemia (AML). The current analysis examined VOD/SOS risk and outcomes in a cohort of patients who in recent years were reported to the Center for International Blood and Marrow Transplant Research. Adults with AML who had GO exposure before myeloablative alloHCT were matched 1:4 by age and disease status at transplant to recipients without GO exposure (control subjects). One hundred thirty-seven patients with GO exposure and 548 matched control subjects who underwent alloHCT between 2008 and 2011 were included in this analysis. With a median ∼8-year follow-up of survivors, the 5-year overall survival probability was similar in the 2 cohorts: 38% and 38% in the GO-exposed versus control groups (P = .97). Incidence of VOD/SOS and severe VOD/SOS, respectively, at 100 days was 4% (95% confidence interval [CI], 1% to 7%) and 3% (95% CI, 1% to 6%) in GO-exposed patients and 3% (95% CI, 2% to 5%) and 1% (95% CI, 0% to 2%) in control subjects. Correspondingly, among patients who developed VOD/SOS, 1-year survival probability after VOD/SOS diagnosis was 33% (95% CI, 5% to 72%) and 27% (95% CI, 11% to 47%; P = .78). In multivariate analyses, GO exposure before alloHCT was not associated with an increased risk of VOD/SOS (odds ratio, 1.10; P = .85) or death (hazard ratio, 1.08; P = .57). Three deaths (3%) in the GO group and 3 deaths (<1%) in the control group were attributed to VOD/SOS. Our results suggest that GO treatment before myeloablative alloHCT in the recent era is not associated with an increased risk of post-transplant VOD/SOS or death.
历史上，急性髓系白血病（AML）患者在异基因造血细胞移植（alloHCT）前接受吉妥单抗奥佐米星（GO）治疗与肝静脉闭塞病/窦性阻塞综合征（VOD/SOS）风险增加有关。本项分析研究了近年来向国际血液和骨髓移植研究中心报告的一组患者的VOD/SOS风险及转归情况。将清髓性alloHCT前接触过GO的成年AML患者按移植时的年龄和疾病状态与未接触过GO的受者（对照对象）以1:4的比例进行匹配。本分析纳入了2008年至2011年间接受alloHCT的137例接触过GO的患者和548例匹配的对照对象。对幸存者进行了约8年的中位随访，两个队列的5年总生存概率相似：接触GO组与对照组分别为38%和38%（P = 0.97）。接触GO的患者100天时VOD/SOS和严重VOD/SOS的发生率分别为4%（95%置信区间[CI]，1%至7%）和3%（95%CI，1%至6%），对照对象分别为3%（95%CI，2%至5%）和1%（95%CI，0%至2%）。相应地，在发生VOD/SOS的患者中，VOD/SOS诊断后的1年生存概率为33%（95%CI，5%至72%）和27%（95%CI，11%至47%；P = 0.78）。在多变量分析中，alloHCT前接触GO与VOD/SOS风险增加（比值比，1.10；P = 0.85）或死亡（风险比，1.08；P = 0.57）无关。GO组有3例死亡（3%），对照组有3例死亡（<1%）归因于VOD/SOS。我们的结果表明，近期清髓性alloHCT前的GO治疗与移植后VOD/SOS风险增加或死亡无关。
