Department of Medicine, Stanford University School of Medicine, Stanford, California.
Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin.
Transplant Cell Ther. 2022 Aug;28(8):490-495. doi: 10.1016/j.jtct.2022.05.010. Epub 2022 May 15.
Allogeneic hematopoietic cell transplantation (HCT) remains an important treatment for adults with acute lymphoblastic leukemia (ALL). We hypothesized that advances in ALL and transplantation have resulted in improved HCT outcomes in recent years. In this study, we evaluated the characteristics and outcomes of adult ALL patients undergoing allogeneic HCT over the last decade. Patients with ALL aged 18 years and older who underwent allogeneic HCT at Stanford University between 2008 and 2019 were included in this study. Patients were divided into 2 eras based on year of HCT: 2008 to 2013 (earlier era) and 2014 to 2019 (later era). A total of 285 patients were included: 119 patients underwent HCT in the earlier era and 166 in the later era. Patients who underwent transplantation in the later era were more likely to be Hispanic (38% versus 21%) and to have an HCT-comorbidity index ≥3 (31% versus 18%). Donor source for HCT also differed with an increase in the use of HLA-mismatched donor sources (38% versus 24%), notably umbilical cord blood in the later era (16% versus 0%). Patients in the later era were less likely to undergo transplantation with active disease (4% versus 16%); pre-HCT rates of measurable residual disease were similar across the eras (38% versus 40%). In unadjusted analyses, overall survival (OS) improved across eras, with 2-year estimates for the later and earlier eras of 73% (95% confidence interval [CI], 66%-80%) versus 55% (95% CI, 46%-64%), respectively. Multivariable analysis confirmed the association between later era and OS (hazard ratio = 0.52, 95% CI, 0.34-0.78). Finally, among patients relapsing after HCT (25% in later era and 33% in earlier era), the use of novel immunotherapies increased in the later era (44% versus 3%), as did the median OS after post-HCT relapse (16 months versus 8 months, P< .001). OS after HCT for adult ALL has improved in recent years. This is due, in part, to a significant improvement in the ability to effectively salvage adults with ALL relapsing after HCT.
异基因造血细胞移植（HCT）仍然是成人急性淋巴细胞白血病（ALL）的重要治疗方法。我们假设，近年来 ALL 和移植方面的进步导致 HCT 结果得到改善。在这项研究中，我们评估了过去十年间接受异基因 HCT 的成人 ALL 患者的特征和结局。本研究纳入了 2008 年至 2019 年期间在斯坦福大学接受异基因 HCT 的年龄在 18 岁及以上的 ALL 患者。患者根据 HCT 年份分为 2 个时期：2008 年至 2013 年（早期）和 2014 年至 2019 年（晚期）。共纳入 285 例患者：119 例患者在早期接受 HCT，166 例患者在晚期接受 HCT。晚期接受 HCT 的患者更有可能为西班牙裔（38%比 21%），且 HCT 合并症指数≥3（31%比 18%）。HCT 的供体来源也有所不同，HLA 不合供体来源的使用率增加（38%比 24%），特别是晚期使用脐带血（16%比 0%）。晚期患者接受移植时疾病活动度较低（4%比 16%）；两个时期的预 HCT 可测量残留疾病率相似（38%比 40%）。在未调整分析中，总体生存率（OS）随时间推移而改善，晚期和早期的 2 年估计值分别为 73%（95%CI，66%-80%）和 55%（95%CI，46%-64%）。多变量分析证实了晚期与 OS 之间的关联（风险比=0.52，95%CI，0.34-0.78）。最后，在接受 HCT 后复发的患者中（晚期为 25%，早期为 33%），晚期使用新型免疫疗法的比例增加（44%比 3%），HCT 后复发后的中位 OS 也延长（16 个月比 8 个月，P<.001）。近年来，成人 ALL 接受 HCT 后的 OS 有所改善。这部分归因于在挽救 HCT 后复发的成人 ALL 方面的能力有了显著提高。
