Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK.
Bone Marrow Transplant. 2022 Nov;57(11):1704-1711. doi: 10.1038/s41409-022-01796-2. Epub 2022 Aug 30.
The optimal chemotherapy regimen pre-transplantation for adult T-cell acute lymphoblastic leukemia (T-ALL) patients remains unknown. Here, we compared the transplant outcomes in 127 subjects receiving pediatric- (N = 57) or adult-type (N = 70) regimens pre-transplant. The corresponding 3-year cumulative incidences of relapse (CIR) was 7% (95% CI: 3-11%) and 29% (95% CI: 23-35%; P = 0.02), leukemia-free survivals (LFS) was 86% (95% CI: 81-91%) and 57% (95% CI: 51-63%; P = 0.003), overall survivals (OS) was 88% (95% CI: 84-92%) and 58% (95% CI: 52-64%; P = 0.002), the 1-year NRM was 4% (95% CI: 1-7%) and 9% (95% CI: 4-14%; P = 0.40). Multivariate analysis showed that pediatric-type regimen was associated with lower CIR (Hazard Ratio [HR] = 0.31 [95% CI: 0.09-1.00]; P = 0.05), better LFS (HR = 0.34 [95% CI: 0.15-0.78]; P = 0.01) and OS (HR = 0.30 [95% CI: 0.13-0.72]; P = 0.01). Our results suggested that adult T-ALL patients undergoing allo-HSCT might benefit from pediatric-type chemotherapy.
移植前成人 T 细胞急性淋巴细胞白血病（T-ALL）患者的最佳化疗方案仍不清楚。在这里，我们比较了 127 例接受儿科（N=57）或成人（N=70）方案预处理的患者的移植结果。相应的 3 年累积复发率（CIR）分别为 7%（95%CI：3-11%）和 29%（95%CI：23-35%；P=0.02），无白血病生存率（LFS）分别为 86%（95%CI：81-91%）和 57%（95%CI：51-63%；P=0.003），总生存率（OS）分别为 88%（95%CI：84-92%）和 58%（95%CI：52-64%；P=0.002），1 年非复发死亡率（NRM）分别为 4%（95%CI：1-7%）和 9%（95%CI：4-14%；P=0.40）。多变量分析显示，儿科类型方案与较低的 CIR 相关（风险比 [HR] = 0.31 [95%CI：0.09-1.00]；P=0.05），更好的 LFS（HR = 0.34 [95%CI：0.15-0.78]；P=0.01）和 OS（HR = 0.30 [95%CI：0.13-0.72]；P=0.01）。我们的结果表明，接受 allo-HSCT 的成人 T-ALL 患者可能受益于儿科类型的化疗。
