Peking University People's Hospital, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
Peking-Tsinghua Center for Life Sciences, Beijing, 100871, China.
Ann Hematol. 2023 Aug;102(8):2241-2250. doi: 10.1007/s00277-023-05324-0. Epub 2023 Jun 21.
There was no consensus on whether prognostic advantages existed when transplant conducted at first complete remission (CR1) stage than at second complete remission (CR2) stage for patients with AML who received haploidentical hematological stem cell transplantation (haplo-HSCT). In 768 consecutive AML patients who received haplo-HSCT from January 2014 to December 2017, a 1:2 ratio matched-pair analysis was performed, 69 patients who in CR2 group and 138 CR1 patients were enrolled. Hematopoietic recovery, graft versus host disease (GVHD), relapse, transplant related mortality (TRM), disease-free survival (DFS) and overall survival (OS) were compared in two groups, and further evaluated in low-, intermediate-, and high-risk subgroups. The cumulative incidences of 30-day myeloid recovery and 90-day platelet recovery were comparable in CR1 and CR2 groups. The cumulative incidences of grade II-IV and grade III-IV aGVHD were not significantly different. The cumulative incidences of relapse at 3-year and 5-year in these two groups were 12.4% versus 11.6% (P = 0.880) and 12.4% versus 17.5% (P = 0.322). The cumulative incidences of TRM at 3-year and 5-year were both 10.9% versus 23.2% (P = 0.019). The probability of DFS at 3-year and 5-year were 76.7% versus 65.2% (P = 0.029) and 76.7% versus 59.3% (P = 0.009). The probability of OS at 3-year and 5-year were 81.8% versus 68.1% (P = 0.026) and 76.7% versus 59.3% (P = 0.026). In the intermediate-risk group, TRM was lower in CR1 group, DFS and OS of CR1 group were superior to CR2 group. In conclusion, haplo-HSCT at CR1 stage was of better prognosis for intermediate-risk AML patients than at CR2 stage.
对于接受单倍体造血干细胞移植（haplo-HSCT）的 AML 患者，在首次完全缓解（CR1）阶段进行移植是否比在第二次完全缓解（CR2）阶段具有预后优势尚无共识。在 2014 年 1 月至 2017 年 12 月期间，768 例连续接受 haplo-HSCT 的 AML 患者中，采用 1:2 比例匹配对分析，入组 69 例 CR2 组和 138 例 CR1 患者。比较两组患者造血恢复、移植物抗宿主病（GVHD）、复发、移植相关死亡率（TRM）、无病生存（DFS）和总生存（OS），并进一步在低、中、高危亚组中进行评估。CR1 组和 CR2 组 30 天髓系恢复和 90 天血小板恢复的累积发生率相当。Ⅱ-Ⅳ级和Ⅲ-Ⅳ级 aGVHD 的累积发生率无显著差异。两组患者 3 年和 5 年复发的累积发生率分别为 12.4%和 11.6%（P=0.880）和 12.4%和 17.5%（P=0.322）。两组患者 3 年和 5 年 TRM 的累积发生率分别为 10.9%和 23.2%（P=0.019）。两组患者 3 年和 5 年 DFS 的概率分别为 76.7%和 65.2%（P=0.029）和 76.7%和 59.3%（P=0.009）。两组患者 3 年和 5 年 OS 的概率分别为 81.8%和 68.1%（P=0.026）和 76.7%和 59.3%（P=0.026）。在中危组中，CR1 组的 TRM 较低，CR1 组的 DFS 和 OS 优于 CR2 组。结论：与 CR2 期相比，CR1 期的单倍体 HSCT 对中危 AML 患者具有更好的预后。
