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自体造血干细胞移植联合白细胞介素-2 治疗完全缓解后具有良好或中等风险的成人急性髓系白血病患者。

Autologous hematopoietic stem cell transplantation followed by interleukin-2 for adult acute myeloid leukemia patients with favorable or intermediate risk after complete remission.

机构信息

Department of Hematology and Institute of Hematology, West China Hospital, Sichuan University, 610041, Chengdu, China.

出版信息

Ann Hematol. 2022 Aug;101(8):1711-1718. doi: 10.1007/s00277-022-04863-2. Epub 2022 May 16.

Abstract

High-dose chemotherapy followed by allogeneic hematopoietic stem cell transplantation (allo-HSCT) is generally the optimal option for patients with acute myeloid leukemia (AML). However, for favorable- and intermediate-risk patients, the regimen remains less understood due to graft versus host disease (GVHD) and increased non-relapsed mortality (NRM) caused by allo-HSCT. Additionally, the benefit of maintenance therapy has not yet been conclusively proven. Here, we conducted a retrospective study on the long-term outcome of AML patients with favorable or intermediate risk who underwent autologous hematopoietic stem cell transplantation (auto-HSCT) followed by interleukin-2 (IL-2) subcutaneous injection as maintenance therapy. A total of 49 patients from 2007 to 2019 were included in our study. They all received a daunorubicin + cytarabine regimen as induction chemotherapy followed by four to six cycles of consolidation therapy with medium- or high-dose cytarabine. Once patients achieved complete remission (CR1), they started receiving auto-HSCT followed by IL-2 injections. The results showed that no patients stopped receiving IL-2 injections on account of adverse side effects, and the 5-year overall survival (OS) and leukemia-free survival (LFS) rates were 85.6 ± 5.0% and 78.5 ± 6.1%, respectively. The multivariate analysis also suggested that age, gender, initial white blood cell (WBC) count, AML subtype, cytogenetic risk, and conditioning regimen did not affect the prognosis. In conclusion, auto-HSCT followed by IL-2 injection is an effective treatment that can improve the prognosis of AML for patients with favorable or intermediate risk.

摘要

大剂量化疗后行异基因造血干细胞移植(allo-HSCT)通常是急性髓系白血病(AML)患者的最佳选择。然而,对于低危和中危患者,由于移植物抗宿主病(GVHD)和 allo-HSCT 导致的非复发死亡率(NRM)增加,该方案的疗效仍不明确。此外,维持治疗的益处尚未得到明确证实。在这里,我们对接受自体造血干细胞移植(auto-HSCT)后接受白细胞介素-2(IL-2)皮下注射作为维持治疗的低危和中危 AML 患者的长期结果进行了回顾性研究。我们共纳入了 2007 年至 2019 年的 49 例患者。他们均接受柔红霉素+阿糖胞苷方案诱导化疗,随后接受中或高剂量阿糖胞苷巩固化疗 4 至 6 个周期。一旦患者达到完全缓解(CR1),他们开始接受 auto-HSCT 后接受 IL-2 注射。结果显示,没有患者因不良反应而停止接受 IL-2 注射,5 年总生存率(OS)和无白血病生存率(LFS)分别为 85.6±5.0%和 78.5±6.1%。多因素分析还表明,年龄、性别、初诊白细胞(WBC)计数、AML 亚型、细胞遗传学风险和预处理方案均不影响预后。总之,auto-HSCT 后行 IL-2 注射是一种有效的治疗方法,可以改善低危和中危 AML 患者的预后。

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