Schmidt Sarah, Liu Ying, Hu Zhen-Huan, Williams Kirsten M, Lazarus Hillard M, Vij Ravi, Kharfan-Dabaja Mohamed A, Ortí Guillermo, Wiernik Peter H, Weisdorf Daniel, Kamble Rammurti T, Herzig Roger, Wirk Baldeep, Cerny Jan, Bacher Ulrike, Chaudhri Naeem A, Nathan Sunita, Farhadfar Nosha, Aljurf Mahmoud, Gergis Usama, Szer Jeffrey, Seo Sachiko, Hsu Jack W, Olsson Richard F, Maharaj Dipnarine, George Biju, Hildebrandt Gerhard C, Agrawal Vaibhav, Nishihori Taiga, Abdel-Azim Hisham, Alyea Edwin, Popat Uday, Sobecks Ronald, Scott Bart L, Holter Chakrabarty Jennifer, Saber Wael
Department of Hematology/Oncology, University of Oklahoma, Oklahoma City, Oklahoma.
CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin.
Biol Blood Marrow Transplant. 2020 Jun;26(6):1137-1143. doi: 10.1016/j.bbmt.2020.02.006. Epub 2020 Feb 14.
Treatment for relapse of chronic myeloid leukemia (CML) following hematopoietic cell transplantation (HCT) includes tyrosine kinase inhibitors (TKIs) with or without donor lymphocyte infusions (DLIs), but the most effective treatment strategy is unknown. This study was performed through the Center for International Blood and Marrow Transplant Research (CIBMTR) database. We retrospectively reviewed all patients reported to the CIBMTR registry from 2002 to 2014 who underwent HCT for CML and were alive 30 days postrelapse. A total of 215 HCT recipients relapsed and were analyzed in the following groups: (1) TKI alone (n = 128), (2) TKI with DLI (n = 48), and (3) DLI without TKI (n = 39). In multivariate analysis, disease status prior to HCT had a significant effect on overall survival (OS). Patients who received a DLI alone compared with a TKI with a DLI had inferior survival (hazard ratio, 2.28; 95% confidence interval, 1.23 to 4.24; P= .009). Those who received a TKI alone had similar survival compared with those who received a TKI with a DLI (P = .81). These data support that despite use of TKIs pretransplantation, TKI salvage therapy continues to provide significant survival following relapse in patients with CML following HCT. These data do not suggest that adding a DLI to a TKI adds an improvement in OS.
造血细胞移植（HCT）后慢性髓性白血病（CML）复发的治疗方法包括使用或不使用供体淋巴细胞输注（DLI）的酪氨酸激酶抑制剂（TKI），但最有效的治疗策略尚不清楚。本研究通过国际血液和骨髓移植研究中心（CIBMTR）数据库进行。我们回顾性分析了2002年至2014年向CIBMTR登记处报告的所有接受HCT治疗CML且复发后存活30天的患者。共有215名HCT受者复发，并被分为以下几组进行分析：（1）仅使用TKI组（n = 128），（2）TKI联合DLI组（n = 48），以及（3）不使用TKI的DLI组（n = 39）。多因素分析显示，HCT前的疾病状态对总生存期（OS）有显著影响。单独接受DLI的患者与接受TKI联合DLI的患者相比，生存期较差（风险比，2.28；95%置信区间，1.23至4.24；P = .009）。单独接受TKI的患者与接受TKI联合DLI的患者生存期相似（P = .81）。这些数据表明，尽管移植前使用了TKI，但TKI挽救治疗在HCT后复发的CML患者中仍能显著延长生存期。这些数据并不表明在TKI基础上加用DLI能改善OS。
