Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
Department of Internal Medicine, Kyushu University Beppu Hospital, Beppu, Japan.
Am J Hematol. 2022 Feb 1;97(2):185-193. doi: 10.1002/ajh.26401. Epub 2021 Nov 16.
We compared characteristics of myeloid neoplasms (MNs) following allogeneic hematopoietic cell transplantation (HCT) versus autologous HCT using a Japanese HCT registry database. Among 43 788 patients who underwent allogeneic (n = 18 874) or autologous HCT (n = 24 914) for non-myeloid malignancies or non-malignant diseases, 352 developed MNs. The cumulative incidence of MNs was lower after allogeneic HCT than after autologous HCT (0.3% vs. 1.8% at 10 years, respectively, p < .001). Compared with autologous HCT, MNs following allogeneic HCT developed in younger patients (median, 42 vs. 57 years old, respectively) and sooner after HCT (median, 16 vs. 33 months, respectively). Approximately half of MNs following allogeneic HCT were donor-derived and occurred later than recipient-derived MNs (median, 26 vs. 6 months, respectively, p = .003). In multivariate analysis, reduced-intensity conditioning and cord blood transplantation were associated with MN development after allogeneic HCT. Overall survival was similar in patients who developed MNs following allogeneic versus autologous HCT (18% vs. 22% at 5 years, respectively, p = .48). Patient age ≥ 55 years, the presence of previous HCT, AML subtype, and chromosome 5 or 7 abnormalities were adverse factors for overall survival after MN diagnosis. Further research is warranted to elucidate the mechanisms of MN development following allogeneic HCT.
我们利用日本造血细胞移植（HCT）注册数据库比较了异基因 HCT 与自体 HCT 后髓系肿瘤（MN）的特征。在因非髓系恶性肿瘤或非恶性疾病而接受异基因（n=18874）或自体 HCT（n=24914）的 43788 例患者中，有 352 例发生 MN。异基因 HCT 后 MN 的累积发生率低于自体 HCT（分别为 10 年时 0.3%与 1.8%，p<.001）。与自体 HCT 相比，异基因 HCT 后 MN 发生于更年轻的患者（中位数，42 岁与 57 岁，分别）且移植后更早（中位数，16 个月与 33 个月，分别）。大约一半的异基因 HCT 后 MN 是供体源性的，且发生时间晚于受体源性 MN（中位数，26 个月与 6 个月，分别，p=.003）。多变量分析显示，减强度预处理和脐带血移植与异基因 HCT 后 MN 的发生相关。发生异基因 HCT 后 MN 的患者与自体 HCT 后 MN 的患者的总生存相似（分别为 5 年时 18%与 22%，p=0.48）。患者年龄≥55 岁、既往 HCT、AML 亚型和染色体 5 或 7 异常是 MN 诊断后总生存的不良因素。需要进一步研究以阐明异基因 HCT 后 MN 发生的机制。
