Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
Division of Hematology, Department of Internal Medicine, Aichi Medical University, Nagakute, Japan.
Transplant Cell Ther. 2022 Nov;28(11):777.e1-777.e11. doi: 10.1016/j.jtct.2022.08.006. Epub 2022 Aug 12.
Relapse is the most common cause of treatment failure after allogeneic hematopoietic cell transplantation (HCT) for acute myeloid leukemia (AML). Second or subsequent allogeneic HCT using unrelated cord blood has been performed for adult patients with AML who have relapsed after a previous allogeneic HCT. Although outcomes after unrelated cord blood transplantation (CBT) as the first allogeneic HCT have significantly improved in recent years, it is unclear whether survival and engraftment improve after CBT as the second or subsequent allogeneic HCT for adult AML patients relapsing after a previous allogeneic HCT. The objective of this retrospective study was to evaluate trends of survival and other transplantation outcomes after single-unit unrelated CBT as a second or subsequent allogeneic HCT in adult patients with relapsed AML after a previous allogeneic HCT over the past 19 years in Japan. We retrospectively assessed survival trends and other outcomes of single-unit unrelated CBT as a second or subsequent allogeneic HCT in adult patients with relapsed AML after a previous allogeneic HCT according to the time period of CBT (2001-2007, 2008-2013, or 2014-2019) using a nationwide Japanese database. The median age was 45 years among 1109 CBTs, and 844 (78.6%) patients were not in complete remission at the time of CBT. Over the 3 time periods, there was a progressive increase in higher cryopreserved cord blood total nucleated cell dose and myeloablative conditioning regimens. The 2-year overall survival was 14.0% in 2001-2007, 19.9% in 2008-2013, and 24.4% in 2014-2019 (P <.001 by log-rank trend test). The 2-year relapse-related mortality was 54.0% in 2001-2007, 44.4% in 2008-2013, and 39.1% in 2014-2019 (P < 0.001 by Gray's test), but nonrelapse mortality was not significantly different across the time periods (P = 0.557 by Gray's test). The 42-day neutrophil engraftment also significantly improved (62.9% in 2001-2007, 69.7% in 2008-2013, and 79.9% in 2014-2019; P < 0.001 by Gray's test). Our data demonstrate significant improvements in overall and relapse-related mortality, as well as neutrophil engraftment, after single-unit unrelated CBT as a second or subsequent allogeneic HCT for adult patients with AML relapsed after previous allogeneic HCT over the past 19 years.
复发是异基因造血细胞移植（HCT）治疗急性髓系白血病（AML）后治疗失败的最常见原因。对于先前异基因 HCT 后复发的 AML 成年患者，已经进行了使用无关脐带血的第二次或随后的异基因 HCT。尽管近年来，无关脐带血移植（CBT）作为第一次异基因 HCT 的结果已经显著改善，但尚不清楚在先前异基因 HCT 后复发的 AML 成年患者中，CBT 作为第二次或随后的异基因 HCT 是否可以改善生存和植入。本回顾性研究的目的是评估过去 19 年中，在日本，对于先前异基因 HCT 后复发的 AML 成年患者，作为第二次或随后的异基因 HCT 的单次单位无关 CBT 的生存和其他移植结果的趋势。我们根据 CBT 的时间（2001-2007 年、2008-2013 年或 2014-2019 年），使用全国性日本数据库，回顾性评估了先前异基因 HCT 后复发的 AML 成年患者，作为第二次或随后的异基因 HCT 的单次单位无关 CBT 的生存趋势和其他结果。在 1109 次 CBT 中，中位年龄为 45 岁，844（78.6%）例患者在 CBT 时未完全缓解。在 3 个时间段中，冷冻保存的脐带血总核细胞剂量和清髓性调理方案均逐渐增加。2001-2007 年的 2 年总生存率为 14.0%，2008-2013 年为 19.9%，2014-2019 年为 24.4%（对数秩趋势检验，P<.001）。2001-2007 年的 2 年复发相关死亡率为 54.0%，2008-2013 年为 44.4%，2014-2019 年为 39.1%（Gray 检验，P<.001），但非复发死亡率在不同时间段之间无显著差异（Gray 检验，P=0.557）。42 天中性粒细胞植入也显著改善（2001-2007 年为 62.9%，2008-2013 年为 69.7%，2014-2019 年为 79.9%；Gray 检验，P<.001）。我们的数据表明，在过去的 19 年中，对于先前异基因 HCT 后复发的 AML 成年患者，单次单位无关 CBT 作为第二次或随后的异基因 HCT，在总体和复发相关死亡率以及中性粒细胞植入方面均有显著改善。
