继发于初次完全缓解期的 AML 与初发 AML 患者接受非 T 细胞耗竭的单倍体相合移植联合移植后环磷酰胺治疗：来自 ALWP/EBMT 的研究。
Non-T-depleted haploidentical transplantation with post-transplant cyclophosphamide in patients with secondary versus de novo AML in first complete remission: a study from the ALWP/EBMT.
机构信息
Division of Hematology, Sheba Medical Center, Tel Hashomer, Israel.
EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France.
出版信息
J Hematol Oncol. 2023 May 29;16(1):58. doi: 10.1186/s13045-023-01450-4.
We compared outcomes of adult patients with secondary acute myeloid leukemia (sAML) versus de novo AML after non-T-depleted haploidentical stem cell transplant (HaploSCT) with post-transplant cyclophosphamide (PTCy). Seventeen hundred and eleven AML patients (sAML-231, de novo-1480) in first complete remission transplanted from 2010 to 2021, were included. Patients with de novo AML were younger, median age 55.8 versus 60.8 years, p < 0.0001, had better transplantation comorbidity index (HCT-CI) ≥ 3 21.3% versus 40.8%, p < 0.0001 and Karnofsky performance status (KPS) with KPS ≥ 90 in 78% versus 68.5%, respectively, p = 0.002. The two patient groups did not differ with respect to gender, cytomegalovirus serostatus, and cell source. Median time from diagnosis to HaploSCT was 5.2 versus 4.9 months, respectively, p = 0.005. Fewer sAML patients received myeloablative conditioning 35.1% versus 50.1%, p < 0.0001. Two hundred and eleven sAML and 410 de novo AML patients were included in the matched-pair analysis matching two de novo AML with each sAML. No significant difference was observed in any transplantation outcome parameter between the sAML versus de novo AML groups. Two-year non-relapse mortality and relapse incidence did not differ with HaploSCT for de novo versus sAML; 21.4% versus 21%, hazard ratio (HR) = 0.98, p = 0.9 and 23.4% versus 20.6%, HR = 0.92, p = 0.67, respectively. Two-year leukemia-free survival, overall survival, and graft-versus-host disease (GVHD)-free, relapse-free survival were also not different between the de novo AML and sAML groups 55.2% versus 58.4%, HR = 0.95, p = 0.67; 61.4% versus 66.4%, HR = 0.91, p = 0.51 and 46.3% versus 48.2%, HR = 0.92, p = 0.48, respectively. Similarly, the incidence of engraftment as well as acute and chronic GVHD was similar between the 2 cohorts. In conclusion, HaploSCT with PTCy may be able to overcome the bad prognosis of sAML as results are not significantly different to those of HaploSCT in de novo AML.
我们比较了非 T 细胞耗竭单倍体造血干细胞移植（HaploSCT）后伴和不伴移植后环磷酰胺（PTCy）的继发性急性髓系白血病（sAML）与初发性急性髓系白血病（de novo AML）患者的结局。2010 年至 2021 年，共纳入 1711 例处于首次完全缓解期的 AML 患者（sAML-231 例，de novo-1480 例）。与 de novo AML 患者相比，sAML 患者年龄更大，中位年龄为 60.8 岁 vs. 55.8 岁，p<0.0001；移植相关合并症指数（HCT-CI）≥3 者占 21.3% vs. 40.8%，p<0.0001；卡氏功能状态（KPS）评分≥90 者占 78% vs. 68.5%，p=0.002。两组患者在性别、巨细胞病毒血清状态和细胞来源方面无差异。sAML 患者从诊断到 HaploSCT 的中位时间为 5.2 个月 vs. 4.9 个月，p=0.005。sAML 患者接受清髓性预处理的比例更低（35.1% vs. 50.1%），p<0.0001。在匹配对分析中，211 例 sAML 和 410 例 de novo AML 患者被匹配，每例 de novo AML 患者匹配 2 例 sAML。与 de novo AML 患者相比，sAML 患者在任何移植结局参数方面均无显著差异。与 de novo AML 患者相比，sAML 患者接受 HaploSCT 后，2 年非复发死亡率和复发率无差异；无复发死亡率分别为 21.4% vs. 21%，危险比（HR）=0.98，p=0.9 和 23.4% vs. 20.6%，HR=0.92，p=0.67。2 年无白血病生存率、总生存率和移植物抗宿主病（GVHD）-无复发生存率在 de novo AML 和 sAML 组之间也无差异，分别为 55.2% vs. 58.4%，HR=0.95，p=0.67；61.4% vs. 66.4%，HR=0.91，p=0.51 和 46.3% vs. 48.2%，HR=0.92，p=0.48。同样，两组患者的植入情况以及急性和慢性 GVHD 的发生率也相似。总之，HaploSCT 联合 PTCy 可能能够克服 sAML 的不良预后，其结果与 HaploSCT 治疗 de novo AML 患者的结果无显著差异。
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