Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Ann Hematol. 2023 Oct;102(10):2879-2893. doi: 10.1007/s00277-023-05356-6. Epub 2023 Jul 21.
Therapy-related acute myeloid leukemia (t-AML) is a therapeutic challenge as a late complication of chemotherapy (CHT) and/or radiotherapy (RT) for primary malignancy. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) presents itself as a curative approach. To establish the optimal allo-HSCT strategy for t-AML, we evaluated the relationship between characteristics of primary malignancy and allo-HSCT outcomes. Patients with t-AML or de novo acute myeloid leukemia (AML) who underwent first allo-HSCT in Japan from 2011 to 2018 were identified using a nationwide database. The detailed background of t-AML was obtained by additional questionnaires. Multivariate analysis and propensity score matching (PSM) analysis were performed to detect the prognostic factors associated with t-AML and compare outcomes with de novo AML. We analyzed 285 t-AML and 6761 de novo AML patients. In patients with t-AML, receiving both CHT and RT for primary malignancy was an independent poor-risk factor for relapse and overall survival (OS) (hazard ratio (HR) 1.62; p = 0.029 and HR 1.65; p = 0.009, reference: CHT alone group), whereas other primary malignancy-related factors had no effect on the outcome. Compared to the CHT alone group, complex karyotypes were significantly increased in the CHT + RT group (86.1% vs. 57.5%, p = 0.007). In the PSM cohort, t-AML patients with prior CHT and RT had significantly worse 3-year OS than those with de novo AML (25.2% and 42.7%; p = 0.009). Our results suggest that prior CHT and RT for primary malignancy may be associated with increased relapse and worse OS of allo-HSCT in t-AML.
治疗相关的急性髓系白血病（t-AML）是一种治疗挑战，作为原发性恶性肿瘤的化疗（CHT）和/或放疗（RT）的晚期并发症。异基因造血干细胞移植（allo-HSCT）是一种有治愈可能的方法。为了确定 t-AML 的最佳 allo-HSCT 策略，我们评估了原发性恶性肿瘤的特征与 allo-HSCT 结果之间的关系。使用全国性数据库确定了 2011 年至 2018 年在日本接受首次 allo-HSCT 的 t-AML 或新发急性髓系白血病（AML）患者。通过额外的问卷调查获得 t-AML 的详细背景。进行多变量分析和倾向评分匹配（PSM）分析，以检测与 t-AML 相关的预后因素，并与新发 AML 的结果进行比较。我们分析了 285 例 t-AML 和 6761 例新发 AML 患者。在 t-AML 患者中，原发恶性肿瘤接受 CHT 和 RT 治疗是复发和总生存（OS）的独立不良风险因素（风险比（HR）1.62；p = 0.029 和 HR 1.65；p = 0.009，参考：仅 CHT 组），而其他原发性恶性肿瘤相关因素对结果没有影响。与仅 CHT 组相比，CHT + RT 组复杂核型明显增加（86.1%比 57.5%，p = 0.007）。在 PSM 队列中，先前接受 CHT 和 RT 治疗的 t-AML 患者与新发 AML 患者相比，3 年 OS 显著更差（25.2%和 42.7%；p = 0.009）。我们的结果表明，原发恶性肿瘤的 CHT 和 RT 可能与 t-AML 的 allo-HSCT 复发率增加和 OS 恶化有关。
