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完全缓解的费城染色体阳性急性髓系白血病患者接受异基因造血细胞移植的疗效

Allogeneic hematopoietic cell transplantation efficacy in patients with Philadelphia chromosome-positive acute myeloid leukemia in complete remission.

作者信息

Mizuno Shohei, Yanada Masamitsu, Kawamura Koji, Masuko Masayoshi, Uchida Naoyuki, Ozawa Yukiyasu, Iwato Koji, Ohashi Kazuteru, Ikegame Kazuhiro, Kim Sung-Won, Tanaka Masatsugu, Eto Tetsuya, Kanda Yoshinobu, Fukuda Takahiro, Atsuta Yoshiko, Yano Shingo, Takami Akiyoshi

机构信息

Division of Hematology, Department of Internal Medicine, Aichi Medical University, Nagakute, Japan.

Department of Hematology and Cell Therapy, Aichi Cancer Center, Nagoya, Japan.

出版信息

Bone Marrow Transplant. 2021 Jan;56(1):232-242. doi: 10.1038/s41409-020-01011-0. Epub 2020 Jul 31.

Abstract

Philadelphia chromosome-positive acute myeloid leukemia (Ph+ AML) confers a dismal prognosis when treated with chemotherapy alone. Data on allogeneic hematopoietic cell transplantation (allo-HCT) outcomes are limited. We retrospectively analyzed 4649 AML patients who received allo-HCT and were in complete remission. Outcomes of Ph+ AML (n = 30), intermediate-risk, and poor-risk AML patients were compared. The 3-year overall survival after allo-HCT was similar in intermediate-risk (62.7%; 95% CI: 61.0-64.3%) and Ph+ AML (73.3%; 95% CI: 51.5-86.4%) groups (P = 0.42); however, it differed significantly between the poor-risk (49.7%; 95% CI: 45.9-53.4%) and Ph+ AML (73.3%; 95% CI: 51.5-86.4%) groups (P = 0.049). Disease-free survival in Ph+ AML patients was comparable to that in intermediate-risk patients but better than that in poor-risk patients. Relapse rates were significantly lower in Ph+ AML patients than in other groups. Non-relapse mortality (NRM) rates were similar among groups. Multivariate analysis showed that Ph+ AML was not a significant predictor of poor prognosis in terms of overall survival, disease-free survival, relapse, and NRM. Our data showed better post-transplant outcomes for Ph+ AML patients than for those with poor-risk AML. Hence, allo-HCT could be a feasible treatment option for Ph+ AML patients.

摘要

费城染色体阳性急性髓系白血病(Ph+ AML)单独接受化疗时预后不佳。关于异基因造血细胞移植(allo-HCT)结果的数据有限。我们回顾性分析了4649例接受allo-HCT且处于完全缓解状态的AML患者。比较了Ph+ AML患者(n = 30)、中危和高危AML患者的结果。中危组(62.7%;95% CI:61.0 - 64.3%)和Ph+ AML组(73.3%;95% CI:51.5 - 86.4%)allo-HCT后的3年总生存率相似(P = 0.42);然而,高危组(49.7%;95% CI:45.9 - 53.4%)和Ph+ AML组(73.3%;95% CI:51.5 - 86.4%)之间存在显著差异(P = 0.049)。Ph+ AML患者的无病生存率与中危患者相当,但优于高危患者。Ph+ AML患者的复发率显著低于其他组。各组间非复发死亡率(NRM)相似。多变量分析显示,就总生存、无病生存、复发和NRM而言,Ph+ AML并非预后不良的显著预测因素。我们的数据显示,Ph+ AML患者移植后的结果优于高危AML患者。因此,allo-HCT可能是Ph+ AML患者的一种可行治疗选择。

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