Department of Hematology and Institute of Hematology, West China Hospital, Sichuan University, 610041, Chengdu, China.
Ann Hematol. 2022 Aug;101(8):1711-1718. doi: 10.1007/s00277-022-04863-2. Epub 2022 May 16.
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.
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。