Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida.
Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida.
Transplant Cell Ther. 2021 Feb;27(2):165.e1-165.e11. doi: 10.1016/j.jtct.2020.10.015. Epub 2020 Dec 11.
Novel high-risk groups have recently been identified in adult acute lymphoblastic leukemia (ALL), including Philadelphia-like, therapy-related, and measurable residual disease after induction therapy. Furthermore, modern targeted therapies have recently been incorporated into ALL management; rituximab for CD20-positive and blinatumomab for measurable residual disease after induction therapy or relapsed or refractory disease. Allogeneic hematopoietic cell transplantation (allo-HCT) is recommended as consolidation therapy for high-risk ALL; however, its relative benefit for these high-risk groups and after novel therapies is unclear. We performed an analysis of posttransplantation outcomes in a cohort of 261 consecutive patients who underwent allo-HCT for ALL at the 3-site Mayo Clinic Cancer Center (January 1, 2008-December 31, 2018). With a median (range) follow-up of 22.4 months (0.5-135.0), the 100-day and 5-year cumulative incidences of nonrelapse mortality rates were 6.5% and 26.7%, respectively. The 5-year cumulative incidences of relapse and death were 22.6% and 46.2%, respectively. The 1-year estimate of the composite endpoint of graft-versus-host disease/relapse-free survival was 39.3%. We observed no associations of novel high-risk groups or modern targeted therapies with overall survival, nonrelapse mortality, or relapse in multivariable analysis. An increased risk of relapse was observed with T-ALL (hazard ratio, 2.16; 95% confidence interval, 1.14-4.09; P = .02) and hypodiploidy/near-triploidy (hazard ratio, 2.84; 95% confidence interval, 1.06-7.62; P = .04). Our analysis suggests that novel high-risk groups derive a similar benefit from allo-HCT as traditional high-risk adult ALL and that novel targeted therapies do not seem to independently predict for posttransplantation outcomes. It also calls for further exploration of maintenance strategies after Allo-HCT to prevent relapse in high-risk subgroups.
最近在成人急性淋巴细胞白血病 (ALL) 中确定了新的高危人群，包括费城样、治疗相关和诱导治疗后可测量残留疾病。此外，现代靶向治疗最近已被纳入 ALL 管理；CD20 阳性患者使用利妥昔单抗，诱导治疗或复发/难治性疾病后使用blinatumomab。异体造血细胞移植 (allo-HCT) 被推荐作为高危 ALL 的巩固治疗；然而，对于这些高危人群和新型治疗方法，其相对益处尚不清楚。我们对在梅奥诊所癌症中心的三个地点连续接受 allo-HCT 治疗 ALL 的 261 例患者的移植后结果进行了分析（2008 年 1 月 1 日至 2018 年 12 月 31 日）。中位（范围）随访时间为 22.4 个月（0.5-135.0），100 天和 5 年无复发生存率的累积发生率分别为 6.5%和 26.7%。5 年复发和死亡率的累积发生率分别为 22.6%和 46.2%。5 年无移植物抗宿主病/无复发存活率的复合终点估计为 39.3%。在多变量分析中，我们未观察到新型高危人群或现代靶向治疗与总生存、无复发生存率或复发相关。在 T-ALL 中观察到复发风险增加（风险比，2.16；95%置信区间，1.14-4.09；P=0.02）和低倍体/近三倍体（风险比，2.84；95%置信区间，1.06-7.62；P=0.04）。我们的分析表明，新型高危人群从 allo-HCT 中获得的益处与传统高危成人 ALL 相似，新型靶向治疗似乎不会独立预测移植后结局。它还呼吁进一步探索 allo-HCT 后的维持策略，以防止高危亚组的复发。
