在接受人类白细胞抗原匹配的同胞异体移植后，处于首次完全缓解期的急性髓细胞白血病患者，接受两疗程以上的移植前巩固治疗有益：一项多中心研究。
More than two courses of pre-transplant consolidation therapy benefits patients with acute myeloid leukemia in the first complete remission who underwent human leukocyte antigen-matched sibling allografts: a multicenter study.
机构信息
Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China.
First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Institute of Blood and Marrow Transplantation, Soochow University, Suzhou, Jiangsu 215006, China.
出版信息
Chin Med J (Engl). 2023 Aug 5;136(15):1855-1863. doi: 10.1097/CM9.0000000000002347.
BACKGROUND
Although the need for consolidation chemotherapy after successful induction therapy is well established in patients with acute myeloid leukemia (AML) in first complete remission (CR1), the value of consolidation chemotherapy before allogeneic hematopoietic stem cell transplantation remains controversial.
METHODS
We retrospectively compared the effect of the number of pre-transplant consolidation chemotherapies on outcomes of human leukocyte antigen-matched sibling stem cell transplantation (MSDT) for patients with AML in CR1 in multicenters across China. In our study, we analyzed data of 373 AML patients in CR1 from three centers across China.
RESULTS
With a median follow-up of 969 days, patients with ≥ 3 courses of consolidation chemotherapy had higher probabilities of leukemia-free survival (LFS) (85.6% vs . 67.0%, P < 0.001) and overall survival (89.2% vs . 78.5%, P = 0.007), and better cumulative incidences of relapse (10.5% vs . 19.6%, P = 0.020) and non-relapse mortality (4.2% vs . 14.9%, P = 0.001) than those with ≤ 2 courses of consolidation chemotherapy. Pre-transplantation minimal residual disease-negative patients with AML in CR1 who received MSDT with ≥ 3 courses of consolidation chemotherapy had a higher probability of LFS (85.9% vs . 67.7%, P = 0.003) and a lower cumulative incidence of relapse (9.6% vs . 23.3%, P = 0.013) than those with ≤ 2 courses.
CONCLUSION
Our results indicate that patients with AML in CR1 who received MSDT might benefit from pre-transplant consolidation chemotherapy.
背景
在首次完全缓解（CR1）的急性髓系白血病（AML）患者中，成功诱导治疗后进行巩固化疗的需求已得到充分证实，但异体造血干细胞移植前巩固化疗的价值仍存在争议。
方法
我们回顾性比较了中国多个中心接受 HLA 匹配的同胞供体造血干细胞移植（MSDT）的 AML-CR1 患者移植前巩固化疗次数对结局的影响。在本研究中，我们分析了来自中国三个中心的 373 例 AML-CR1 患者的数据。
结果
中位随访 969 天后，接受≥3 疗程巩固化疗的患者无白血病生存率（LFS）（85.6%比 67.0%，P<0.001）和总生存率（89.2%比 78.5%，P=0.007）更高，复发累积发生率（10.5%比 19.6%，P=0.020）和非复发死亡率（4.2%比 14.9%，P=0.001）更低。接受≥3 疗程巩固化疗的 AML-CR1 患者移植前微小残留病阴性患者具有更高的 LFS 概率（85.9%比 67.7%，P=0.003）和更低的复发累积发生率（9.6%比 23.3%，P=0.013）。
结论
我们的结果表明，接受 MSDT 的 AML-CR1 患者可能受益于移植前巩固化疗。
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