National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China.
Hematology. 2021 Dec;26(1):65-74. doi: 10.1080/16078454.2020.1868783.
To analyze the outcomes of patients who received autologous stem cell transplantation (auto-SCT), matched sibling donor stem cell transplantation (MSD-SCT) and haploidentical stem cell transplantation (haplo-SCT) and provide the basis for the choice of transplantation method in Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL). We retrospectively investigated the outcomes of 119 adult patients with Ph+ ALL in our center. The overall survival (OS) rate, leukemia-free survival (LFS) rate, cumulative incidence of relapse (CIR) rate, non-relapse mortality (NRM) rate and the impact of achievement of complete molecular response (CMR) within 3 months and sustaining CMR up to transplantation (s3CMR) on transplantation method were explored. The estimated OS, LFS, CIR and NRM rates at 3 years were not significantly different among three groups (=0.960, 0.917, 0.375 and 0.096, respectively). For the 65 patients who achieved s3CMR, there was no significant difference in OS (84.5% vs 72.5% vs 100%, =0.374), LFS (75.2% vs 64.5% vs 83.3%, =0.668), CIR (17.2% vs 8.1% vs 16.7%, =0.583) and NRM (3.1% vs 23.4% vs 0%, =0.055) among auto-SCT group, MSD-SCT group and haplo-SCT group. However, in patients who did not achieve s3CMR, auto-SCT recipients tended to have higher CIR (60% vs 33.2% vs 24.0%, =0.013) than the allo-HSCT group. Auto-SCT with maintenance therapy after HSCT appears to be an attractive treatment option for patients with Ph+ ALL especially for those whose s3CMR was kept up to transplantation. For non-s3CMR patients, allogeneic transplantation may be more effective from lower relapse.
分析接受自体干细胞移植(auto-SCT)、匹配同胞供体干细胞移植(MSD-SCT)和单倍体干细胞移植(haplo-SCT)的患者的结果，并为费城染色体阳性急性淋巴细胞白血病(Ph+ ALL)的移植方法选择提供依据。我们回顾性研究了我院 119 例成人 Ph+ ALL 患者的结果。探讨了总生存率(OS)、无白血病生存率(LFS)、累积复发率(CIR)、非复发死亡率(NRM)和 3 个月内达到完全分子缓解(CMR)并持续缓解至移植(s3CMR)对移植方法的影响。三组患者的 3 年 OS、LFS、CIR 和 NRM 估计率无显著差异(分别为 0.960、0.917、0.375 和 0.096)。对于 65 例达到 s3CMR 的患者，OS(84.5% vs 72.5% vs 100%，=0.374)、LFS(75.2% vs 64.5% vs 83.3%，=0.668)、CIR(17.2% vs 8.1% vs 16.7%，=0.583)和 NRM(3.1% vs 23.4% vs 0%，=0.055)在 auto-SCT 组、MSD-SCT 组和 haplo-SCT 组之间无显著差异。然而，在未达到 s3CMR 的患者中，auto-SCT 组的 CIR(60% vs 33.2% vs 24.0%，=0.013)高于 allo-HSCT 组。HSCT 后维持治疗的 auto-SCT 似乎是 Ph+ ALL 患者的一种有吸引力的治疗选择，特别是对于那些 s3CMR 持续至移植的患者。对于非 s3CMR 患者，异体移植可能从较低的复发率来看更为有效。
