成人中危急性髓系白血病患者在首次完全缓解期且无微小残留病灶可检测时行自体干细胞移植。全球委员会和 EBMT 的 ALWP 进行的亲缘单倍体移植的比较回顾性研究。
Autologous stem cell transplantation in adult patients with intermediate-risk acute myeloid leukemia in first complete remission and no detectable minimal residual disease. A comparative retrospective study with haploidentical transplants of the global committee and the ALWP of the EBMT.
机构信息
National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, AP-HP, Sorbonne University, EBMT Paris office, Paris, France.
出版信息
Bone Marrow Transplant. 2023 Dec;58(12):1322-1330. doi: 10.1038/s41409-023-02070-9. Epub 2023 Aug 28.
In patients with acute myeloid leukemia (AML) of intermediate-risk (IR) in first remission (CR1) with no measurable residual disease (MRD negative), the choice of the best consolidation is questionable. 1122 adult patients from 196 centers, transplanted in 2010-21 were analyzed: 547 received an autologous stem cell transplantation (ASCT) and 575 a Haploidentical donor transplant. Because of a significant interaction, comparisons were done separately for patients with wild-type FLT3 (FLT3-wt) and FLT3-ITD mutation (FLT3-ITD). In FLT3-wt patients, haploidentical transplants had two year lower relapse incidence (RI) (16.9% versus 32.6%; HR = 0.40, p < 0.001), higher NRM higher (17.2% vs 3.5%; HR = 7.02, p < 0.001), similar LFS (65.9% vs 63.8%; p = 0.37) and lower OS (73.2% vs 80.6%; HR = 1.69, p = 0.018). In FLT3-ITD patients, haploidentical transplants had two year lower RI (8.2% vs 47.8%; HR = 0.14, p < 0.001) higher NRM (20.2% vs 5.6%; HR = 3.43, p = 0.002), better LFS (71.5% vs 46.6%; HR = 0.53, p = 0.007) and similar OS (73.5% vs 61.9%; p = 0.44). In IR AML patients with FLT3-wt in MRD negative CR1, autologous stem cell transplantation is a valid option, while in patients with FLT3-ITD, haploidentical transplant is better. Whether autologous transplantation is superior to chemotherapy in FLT3-wt patients and the role of maintenance therapy with FLT3 inhibitors remain to be studied.
在无微小残留病（MRD 阴性）的中危（IR）急性髓系白血病（AML）首次缓解（CR1）患者中，最佳巩固治疗方案的选择仍存在争议。对 2010-2021 年 196 个中心的 1122 例成人患者进行了分析：547 例接受了自体干细胞移植（ASCT），575 例接受了单倍体相合供者移植。由于存在显著的交互作用，因此分别对野生型 FLT3（FLT3-wt）和 FLT3 内部串联重复突变（FLT3-ITD）患者进行了比较。在 FLT3-wt 患者中，单倍体相合移植的 2 年复发率（RI）较低（16.9% vs 32.6%；HR=0.40，p<0.001），非复发死亡率（NRM）较高（17.2% vs 3.5%；HR=7.02，p<0.001），无事件生存率（EFS）相似（65.9% vs 63.8%；p=0.37），总生存率（OS）较低（73.2% vs 80.6%；HR=1.69，p=0.018）。在 FLT3-ITD 患者中，单倍体相合移植的 2 年 RI 较低（8.2% vs 47.8%；HR=0.14，p<0.001），NRM 较高（20.2% vs 5.6%；HR=3.43，p=0.002），EFS 较好（71.5% vs 46.6%；HR=0.53，p=0.007），OS 相似（73.5% vs 61.9%；p=0.44）。在 MRD 阴性 CR1 的中危 AML 患者中，FLT3-wt 患者自体干细胞移植是一种有效的选择，而在 FLT3-ITD 患者中，单倍体相合移植则更好。FLT3-wt 患者中自体移植是否优于化疗，以及 FLT3 抑制剂维持治疗的作用仍有待研究。
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