allo-HCT 在一线 Hyper-CVAD 后作为适合移植的成人淋巴母细胞白血病/淋巴瘤缓解后治疗的作用。

Role of Allogeneic HCT as Postremission Therapy for Transplant-Eligible Adult Lymphoblastic Leukemia/Lymphoma After Frontline Hyper-CVAD.

机构信息

Department of Oncology, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.

Department of Oncology, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.

出版信息

Clin Lymphoma Myeloma Leuk. 2020 Oct;20(10):690-696. doi: 10.1016/j.clml.2020.05.012. Epub 2020 May 21.

DOI:10.1016/j.clml.2020.05.012

PMID:32636149

Abstract

BACKGROUND

Hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with cytarabine and methotrexate (hyper-CVAD) is a commonly used regimen in adults with acute lymphoblastic leukemia (ALL)/lymphoblastic lymphoma (LBL). Adult patients fit for pediatric-inspired protocols have an excellent outcome with chemotherapy alone. However, it is unclear whether patients receiving hyper-CVAD should undergo allogeneic hematopoietic cell transplantation (HCT) as postremission therapy. Our aim was to examine the role of HCT at first complete remission (CR1) in adult ALL/LBL after hyper-CVAD.

PATIENTS AND METHODS

Adult patients with newly diagnosed ALL/LBL receiving frontline hyper-CVAD from 2008 to 2018 were identified and records retrospectively extracted.

RESULTS

A total of 85 patients were identified and included for further analysis. The median (range) age was 23 (14-68) years, and 56 (66%) were male. A total of 24 (28%) had adverse cytogenetics, and 48 (56%) had at least one risk factor. All patients received hyper-CVAD as induction; induction failure was seen in 10 (12%). A total of 38 patients continued the hyper-CVAD course, while the remaining 47 received HCT in CR1. Three-year event-free survival (EFS) and overall survival for the entire cohort were 51.4% and 61.6%, respectively. Median follow-up of alive patients was 39.9 (3.8-123.8) months. At multivariable analysis for EFS, induction failure was associated with worse outcome (hazard ratio [HR], 4.8; 95% confidence interval [CI] 1.7-13.7; P = .003), whereas HCT in CR1 improved outcome (HR, 0.42; 95% CI 0.18-0.97; P = .044). Furthermore, HCT in CR1 was the only prognostic factor for overall survival (HR, 0.3; 95% CI 0.11-0.85; P = .023).

CONCLUSION

HCT at CR1 resulted in a favorable EFS and overall survival in ALL/LBL patients after hyper-CVAD frontline therapy. Given that hyper-CVAD is a widely used protocol for adult patients, further examination of this observation is warranted.

摘要

背景

高剂量环磷酰胺、长春新碱、多柔比星和地塞米松与阿糖胞苷和甲氨蝶呤交替使用（hyper-CVAD）是成人急性淋巴细胞白血病（ALL）/淋巴母细胞淋巴瘤（LBL）的常用方案。适合儿科方案的成人患者单独接受化疗即可获得良好的疗效。然而，接受 hyper-CVAD 的患者是否应接受缓解后异基因造血细胞移植（HCT）作为治疗尚不清楚。我们的目的是研究 hyper-CVAD 后成人 ALL/LBL 患者在首次完全缓解（CR1）时 HCT 的作用。

患者和方法

从 2008 年至 2018 年，我们确定了接受一线 hyper-CVAD 治疗的新诊断 ALL/LBL 成年患者，并回顾性提取记录。

结果

共确定 85 例患者进行进一步分析。中位（范围）年龄为 23（14-68）岁，56 例（66%）为男性。24 例（28%）存在不良细胞遗传学，48 例（56%）存在至少一个危险因素。所有患者均接受 hyper-CVAD 作为诱导治疗；10 例（12%）诱导失败。38 例患者继续 hyper-CVAD 疗程，其余 47 例患者在 CR1 时接受 HCT。整个队列的 3 年无事件生存率（EFS）和总生存率分别为 51.4%和 61.6%。存活患者的中位随访时间为 39.9（3.8-123.8）个月。多变量分析显示，诱导失败与预后不良相关（风险比[HR]，4.8；95%置信区间[CI]，1.7-13.7；P =.003），而 CR1 时的 HCT 可改善预后（HR，0.42；95%CI，0.18-0.97；P =.044）。此外，CR1 时的 HCT 是唯一影响总生存率的预后因素（HR，0.3；95%CI，0.11-0.85；P =.023）。