Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, 39 Ze'ev Jabotinsky Rd, 49100, Petah-Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Ann Hematol. 2022 Feb;101(2):379-387. doi: 10.1007/s00277-021-04693-8. Epub 2021 Oct 9.
The combination of hypomethylating agents and venetoclax has revolutionized the therapeutic landscape of acute myeloid leukemia (AML), especially for patients previously deemed unfit for curative-intent treatment. Some of these patients undergo allogeneic hematopoietic cell transplant (alloHCT); yet, there are scarce data regarding transplantation outcomes. We conducted a multicenter nationwide retrospective cohort study, including patients with AML who underwent alloHCT in CR1 after frontline treatment with azacitidine plus venetoclax only (aza-ven group). We collected a historical control group of patients who achieved CR1 after first-line intensive chemotherapy only, followed by alloHCT (intensive group). Patients in the aza-ven group (n = 24) were transplanted between 2019 and 2021. Compared to the intensive group, patients in the aza-ven group were older (median age 71.7 vs. 58.4 years), had higher incidence of therapy-related AML and AML with antecedent hematologic disorder and had more often adverse cytogenetics. They had a higher percentage of allografts from matched-unrelated donors, and reduced intensity conditioning was more commonly used. The estimated 12 months non relapse mortality was 19.1% in the aza-ven group and 11.8% in the intensive group. The estimated 12 months relapse-free survival and overall survival were 58% and 63% in the aza-ven group and 54% and 70% in the intensive group, respectively. The cumulative incidence of acute GVHD at 6 months and of chronic GVHD at 12 months were 58% and 40% in the aza-ven group and 62% and 42% in the intensive group, respectively. Analysis of the aza-ven group revealed that HCT-CI score and ELN risk category were predictive of RFS in both univariate analysis as well as multivariate analysis. Our data suggests that alloHCT for AML patients achieving first CR with aza-ven appears feasible, with short-term post-transplant outcomes similar to those expected after traditional intensive chemotherapy.
低甲基化剂联合维奈托克彻底改变了急性髓系白血病（AML）的治疗格局，尤其是对先前认为不适合进行根治性治疗的患者。这些患者中的一些接受异基因造血细胞移植（alloHCT）；然而，关于移植结果的数据很少。我们进行了一项多中心全国性回顾性队列研究，包括在一线阿扎胞苷联合维奈托克治疗后达到完全缓解 1 期（CR1）的 AML 患者接受 alloHCT 的患者（aza-ven 组）。我们收集了一组历史对照患者，他们在接受一线强化化疗后达到 CR1，随后接受 alloHCT（强化组）。aza-ven 组（n=24）的患者在 2019 年至 2021 年期间接受移植。与强化组相比，aza-ven 组患者年龄较大（中位年龄 71.7 岁 vs. 58.4 岁），治疗相关 AML 和 AML 伴前驱血液病的发生率较高，不良细胞遗传学更为常见。他们接受匹配无关供体的同种异体移植物的比例更高，并且更常使用强度降低的调理方案。aza-ven 组的 12 个月非复发死亡率为 19.1%，强化组为 11.8%。aza-ven 组的 12 个月无复发生存率和总生存率分别为 58%和 63%，强化组分别为 54%和 70%。aza-ven 组的 6 个月急性移植物抗宿主病累积发生率和 12 个月慢性移植物抗宿主病累积发生率分别为 58%和 40%，强化组分别为 62%和 42%。aza-ven 组的分析表明，HCT-CI 评分和 ELN 风险类别在单因素分析和多因素分析中均预测 RFS。我们的数据表明，在 azacitidine 联合 venetoclax 治疗后达到首次完全缓解的 AML 患者进行 alloHCT 是可行的，其移植后短期结果与传统强化化疗后预期的结果相似。
