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与根据2017年欧洲白血病网风险分层的高危组相比,在接受异基因造血干细胞移植的诊断时具有中危或高危风险的急性髓系白血病(AML)患者中,对强化化疗的缓解深度具有显著的预后价值。

Depth of Response to Intensive Chemotherapy Has Significant Prognostic Value among Acute Myeloid Leukemia (AML) Patients Undergoing Allogeneic Hematopoietic Stem-Cell Transplantation with Intermediate or Adverse Risk at Diagnosis Compared to At-Risk Group According to European Leukemia Net 2017 Risk Stratification.

作者信息

Kim Tong-Yoon, Park Silvia, Kwag Daehun, Lee Jong-Hyuk, Lee Joonyeop, Min Gi-June, Park Sung-Soo, Jeon Young-Woo, Shin Seung-Hawn, Yahng Seung-Ah, Yoon Jae-Ho, Lee Sung-Eun, Cho Byung-Sik, Eom Ki-Seong, Kim Yoo-Jin, Lee Seok, Min Chang-Ki, Cho Seok-Goo, Lee Jong-Wook, Kim Hee-Je

机构信息

Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.

Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.

出版信息

Cancers (Basel). 2022 Jun 29;14(13):3199. doi: 10.3390/cancers14133199.

Abstract

We evaluated the prognostic efficiency of the European Leukemia Net (ELN) 2017 criteria on the post-transplant outcomes of 174 patients with intermediate (INT; n = 108, 62%) or adverse (ADV) risk (n = 66, 38%) of acute myeloid leukemia; these patients had received the first allogeneic hematopoietic stem-cell transplantation (HSCT) at remission. After a median follow-up period of 18 months, the 2 year OS, RFS, and CIR after HSCT were estimated to be 58.6% vs. 64.4% (p = 0.299), 50.5% vs. 53.7% (p = 0.533), and 26.9% vs. 36.9% (p = 0.060) in the INT and ADV risk groups, respectively. Compared to the ELN 2017 stratification, pre-HSCT WT1 levels (cutoff: 250 copies/104 ABL) more effectively segregated the post-HSCT outcomes of INT risk patients compared to ADV risk patients regarding their 2 year OS (64.2% vs. 51.5%, p = 0.099), RFS (59.4% vs. 32.4%, p = 0.003), and CIR (18.9% vs. 60.0% p < 0.001). Indeed, high WT1 levels were more prominent in INT risk patients than in ADV risk patients. Notably, FLT3-ITD had the greatest impact on post-HSCT outcomes among all the ELN 2017 criteria components; patients in the FLT3-ITD mutant subgroups exhibited the worst outcomes regardless of their allelic ratios or NPM1 status compared to the pre-HSCT WT1 level of other INT and ADV risk patients.

摘要

我们评估了欧洲白血病网络(ELN)2017标准对174例急性髓系白血病处于中危(INT;n = 108,62%)或高危(ADV;n = 66,38%)风险患者移植后结局的预后评估效能;这些患者在缓解期接受了首次异基因造血干细胞移植(HSCT)。在中位随访期18个月后,HSCT后2年总生存期(OS)、无复发生存期(RFS)和累积复发率(CIR)在INT和ADV风险组中分别估计为58.6%对64.4%(p = 0.299)、50.5%对53.7%(p = 0.533)和26.9%对36.9%(p = 0.060)。与ELN 2017分层相比,HSCT前WT1水平(临界值:250拷贝/104 ABL)在区分INT风险患者与ADV风险患者HSCT后2年OS(64.2%对51.5%,p = 0.099)、RFS(59.4%对32.4%,p = 0.003)和CIR(18.9%对60.0%,p < 0.001)方面,能更有效地将INT风险患者的HSCT后结局区分开来。实际上,INT风险患者中高WT1水平比ADV风险患者更为显著。值得注意的是,在所有ELN 2017标准组成部分中,FLT3-ITD对HSCT后结局的影响最大;与其他INT和ADV风险患者的HSCT前WT1水平相比,FLT3-ITD突变亚组的患者无论其等位基因比例或NPM1状态如何,均表现出最差的结局。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f24a/9265052/57cd5fb07455/cancers-14-03199-g001.jpg

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