Rautenberg Christina, Bergmann Anika, Germing Ulrich, Fischermanns Caroline, Pechtel Sabrina, Kaivers Jennifer, Jäger Paul, Schuler Esther, Haas Rainer, Kobbe Guido, Schroeder Thomas
Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, Medical Faculty, Heinrich Heine-University, Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany.
Cancers (Basel). 2020 Aug 12;12(8):2255. doi: 10.3390/cancers12082255.
To provide long-term outcome data and predictors for response and survival, we retrospectively analyzed all 151 patients with relapse of myeloid neoplasms after allogeneic hematopoietic stem cell transplantation (allo-HSCT) who were uniformly treated with first-line azacitidine (Aza) salvage therapy at our center. Patients were treated for molecular (39%) or hematologic relapse (61%), with a median of 5 cycles of Aza and at least one donor lymphocyte infusion in 70% of patients. Overall response was 46%, with 41% achieving complete (CR) and 5% achieving partial remission. CR was achieved after a median of 4 cycles and lasted for a median of 11 months (range 0.9 to 120 months). With a median follow-up of 22 months (range: 1 to 122 months), the 2-year survival rate was 38% ± 9%, including 17 patients with ongoing remission for >5 years. Based on results from multivariate analyses, molecular relapse and time to relapse were integrated into a score, clearly dividing patients into 3 subgroups with CR rates of 71%, 39%, and 29%; and 2-year survival rates of 64%, 38%, and 27%, respectively. In the subgroup of MDS and secondary AML, receiving upfront transplantation was associated with superior response and survival, and therefore pretransplant strategy was integrated together with relapse type into a MDS-sAML-specific score. Overall, Aza enables meaningful responses and long-term survival, which is a predictable with a simple-to-use scoring system.
为了提供缓解和生存的长期结果数据及预测因素，我们回顾性分析了在本中心接受一线阿扎胞苷（Aza）挽救治疗的151例异基因造血干细胞移植（allo-HSCT）后髓系肿瘤复发的患者。患者因分子复发（39%）或血液学复发（61%）接受治疗，Aza治疗的中位周期数为5个，70%的患者至少接受过一次供体淋巴细胞输注。总体缓解率为46%，其中41%达到完全缓解（CR），5%达到部分缓解。CR在中位4个周期后实现，持续时间的中位数为11个月（范围0.9至120个月）。中位随访22个月（范围：1至122个月），2年生存率为38%±9%，包括17例持续缓解超过5年的患者。基于多变量分析结果，将分子复发和复发时间整合为一个评分，可将患者明确分为3个亚组，CR率分别为71%、39%和29%；2年生存率分别为64%、38%和27%。在骨髓增生异常综合征（MDS）和继发性急性髓系白血病（sAML）亚组中，接受早期移植与更好的缓解和生存相关，因此将移植前策略与复发类型整合为一个MDS-sAML特异性评分。总体而言，Aza可带来有意义的缓解和长期生存，这可通过一个简单易用的评分系统进行预测。
