Zhang Y M, Zhang Y, Ni X, Gao L, Qiu H Y, Zhang Y S, Tang G S, Chen J, Zhang W P, Wang J M, Yang J M, Hu X X
Department of Hematology, Changhai Hospital, the Naval Medical University; Institute of Hematologic Disease of Chinese PLA, Shanghai 200433, China.
Zhonghua Xue Ye Xue Za Zhi. 2020 Jan 14;41(1):16-22. doi: 10.3760/cma.j.issn.0253-2727.2020.01.004.
To probe the prognostic value of consolidation chemotherapy in non-favorable acute myeloid leukemia (AML) patients who were candidates for allogeneic hematopoietic stem cell transplantation (allo-HSCT) with first complete remission (CR(1)) and negative minimal residual disease (MRD(-)) . A retrospective analysis was conducted on 155 patients with non-favorable AML who received allo-HSCT in CR(1)/MRD(-) from January 2010 to March 2019. The survival data were compared between patients who received and those not received pre-transplant consolidation chemotherapy. A total of 102 patients received pre-transplant consolidation chemotherapy (consolidation group) , and 53 cases directly proceeded to allo-HSCT when CR(1)/MRD(-) was achieved (nonconsolidation group) . The median ages were 39 (18-56) years old and 38 (19-67) years old, respectively. Five-year post-transplant overall survival [ (59.3±7.5) % (62.2±6.9) %, =0.919] and relapse-free survival [ (53.0±8.9) % (61.6±7.0) %, =0.936] were not significantly different between the two groups (consolidation nonconsolidation) . There was a weak relationship between consolidation therapy and cumulative incidence of relapse [consolidation: (21.9±5.4) % nonconsolidation: (18.3±6.0) %, =0.942], as well as non-relapse mortality [consolidation: (22.4±4.3) % nonconsolidation: (28.4±6.5) %,=0.464]. Multivariate analysis indicated that pre-transplant consolidation and the consolidation courses (< 2 ≥2 courses) did not have an impact on allo-HSCT outcomes. Allo-HSCT for candidate patients without further consolidation when CR(1)/MRD(-) was attained was feasible.
探讨巩固化疗对首次完全缓解(CR(1))且微小残留病阴性(MRD(-))、适合接受异基因造血干细胞移植(allo-HSCT)的非预后良好型急性髓系白血病(AML)患者的预后价值。对2010年1月至2019年3月期间155例CR(1)/MRD(-)时接受allo-HSCT的非预后良好型AML患者进行回顾性分析。比较接受和未接受移植前巩固化疗患者的生存数据。共有102例患者接受了移植前巩固化疗(巩固组),53例患者在达到CR(1)/MRD(-)时直接进行allo-HSCT(非巩固组)。两组的中位年龄分别为39(18 - 56)岁和38(19 - 67)岁。两组(巩固组与非巩固组)的移植后5年总生存率[(59.3±7.5)% 对(62.2±6.9)%,P = 0.919]和无复发生存率[(53.0±8.9)% 对(61.6±7.0)%,P = 0.936]无显著差异。巩固治疗与复发累积发生率[巩固组:(21.9±5.4)% 非巩固组:(18.3±6.0)%,P = 0.942]以及非复发死亡率[巩固组:(22.4±4.3)% 非巩固组:(28.4±6.5)%,P = 0.464]之间存在微弱关系。多因素分析表明,移植前巩固治疗及巩固疗程(<2疗程与≥2疗程)对allo-HSCT结局无影响。对于达到CR(1)/MRD(-)时无需进一步巩固的候选患者进行allo-HSCT是可行的。