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新型前列腺根治性切除术(PhALL)移植结局指标:当前分子无复发生存率。

Novel Indicators of Transplant Outcomes for PhALL: Current Molecular-Relapse-Free Survival.

机构信息

Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan.

Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan.

出版信息

Transplant Cell Ther. 2021 Sep;27(9):800.e1-800.e8. doi: 10.1016/j.jtct.2021.06.020. Epub 2021 Jun 24.

Abstract

Molecular relapse after allogeneic hematopoietic cell transplantation (allo-HCT) has been thought to predict clinical relapse in patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (PhALL). Tyrosine kinase inhibitor (TKI) administration after allo-HCT may dynamically change the status from molecular relapse to molecular remission, but these state changes cannot be accurately represented by conventional survival indicators such as relapse-free survival, where events are usually considered irreversible. We aimed to develop novel indicators of transplant outcomes for allo-HCT recipients with PhALL and to visualize current molecular-relapse-free survival (CMRFS) and current on-TKI status (CTKI), treating molecular relapse or TKI administration after allo-HCT as a reversible event. We retrospectively analyzed 286 patients with PhALL who received allo-HCT between 2000 and 2016 in order to develop the indicators. CMRFS was defined as the probability of molecular remission without clinical relapse or death at any time after allo-HCT. Similarly, CTKI was defined as the probability of TKI administration without clinical relapse or death at any time after allo-HCT. The 1- and 5-year CMRFS rates were 67% and 59%, respectively, whereas the 1- and 5-year conventional molecular relapse-free survival rates were 42% and 37%. The 1- and 5-year CTKI rates were 14% and 8%, respectively. In a post hoc analysis focusing on patients who had achieved a molecular complete remission within 6 weeks (n = 201), the 5-year CMRFS rate (71%) was similar to the 5-year conventional molecular relapse-free survival (molRFS) rate (70%) in the non-TKI group. On the other hand, the 5-year CMRFS rate in the TKI group was 61%, whereas the 5-year conventional molRFS rate was only 38%. CMRFS and CTKI might become useful indicators of transplant success in terms of survival, leukemia-free status, and treatment-free status at any time point. Future extension of these survival models to other clinical situations is warranted.

摘要

异基因造血细胞移植(allo-HCT)后分子复发被认为可预测费城染色体阳性急性淋巴细胞白血病(PhALL)患者的临床复发。allo-HCT 后酪氨酸激酶抑制剂(TKI)的给药可能会使状态从分子复发动态转变为分子缓解,但这些状态变化不能通过传统的无复发生存等生存指标准确表示,其中事件通常被认为是不可逆转的。我们旨在为接受 allo-HCT 的 PhALL 患者开发新的移植结果指标,并可视化当前的分子无复发生存率(CMRFS)和当前的 TKI 状态(CTKI),将 allo-HCT 后的分子复发或 TKI 给药视为可逆事件。我们回顾性分析了 2000 年至 2016 年间接受 allo-HCT 的 286 例 PhALL 患者,以开发这些指标。CMRFS 定义为 allo-HCT 后任何时间无临床复发或死亡的分子缓解概率。同样,CTKI 定义为 allo-HCT 后任何时间无临床复发或死亡的 TKI 给药概率。1 年和 5 年的 CMRFS 率分别为 67%和 59%,而 1 年和 5 年的传统分子无复发生存率分别为 42%和 37%。1 年和 5 年的 CTKI 率分别为 14%和 8%。在一项侧重于在 6 周内达到分子完全缓解的患者(n=201)的事后分析中,5 年 CMRFS 率(71%)与非 TKI 组的 5 年传统分子无复发生存率(molRFS)率(70%)相似。另一方面,TKI 组的 5 年 CMRFS 率为 61%,而传统 molRFS 率仅为 38%。CMRFS 和 CTKI 可能成为在任何时间点生存、无白血病状态和无治疗状态方面的移植成功的有用指标。未来有必要将这些生存模型扩展到其他临床情况。

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