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异基因造血干细胞移植治疗成人治疗相关性急性髓系白血病:SFGM-TC 代表的回顾性多中心研究。

Allogeneic hematopoietic stem cell transplantation for adults with therapy-related acute myeloid leukaemia: a retrospective multicentre study on behalf of the SFGM-TC.

机构信息

Département d'hématologie clinique, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Priest-en-Jarez, France.

Département Universitaire de Recherche et d'Enseignement, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Priest-en-Jarez, France.

出版信息

Bone Marrow Transplant. 2023 Dec;58(12):1331-1338. doi: 10.1038/s41409-023-02082-5. Epub 2023 Aug 31.

Abstract

We report the results from a multicentre retrospective study of 220 adult patients who underwent allogeneic hematopoietic stem cell transplantation (alloHSCT) for therapy-related acute myeloid leukaemia (t-AML). Median age at t-AML diagnosis was 56 years, with a prior history of haematological (45%) or breast (34%). Median time from cytotoxic exposure to t-AML diagnosis was 54.7 months. At transplant, around 20% of patients had measurable residual disease and 3% of patients were not in complete remission. The median follow-up was 21.4 months (Q1-Q3, 5.9-52.8). At 12 months, overall survival (OS), event-free survival (EFS), and graft-versus-host-disease (GVHD)-free-relapse-free survival (GRFS) were 60.7% (95% CI 54.6-67.5), 52.8% (95% CI 46.5-68.4), and 44.1% (95% CI 37.6-51.8), respectively. At 5 years, OS, EFS, and GRFS were 44.1% (95% CI 37.4-52.1), 40.4% (95% CI 33.9-48.1), and 35.3% (95% CI 28.8-43.3), respectively. At last follow-up, 44% of patients were in complete remission (n = 96) and transplant-related mortality accounted for 21% of all deaths (n = 119). Multivariable analysis revealed that uncontrolled t-AML at transplant was associated with lower EFS (HR 1.94, 95% CI 1.0-3.7, p = 0.041). In conclusion, alloHSCT for t-AML shows encouraging results and offers additional opportunity with the emergence of novel pre-graft therapies.

摘要

我们报告了一项多中心回顾性研究的结果,该研究纳入了 220 例接受异基因造血干细胞移植(alloHSCT)治疗治疗相关急性髓系白血病(t-AML)的成年患者。t-AML 诊断时的中位年龄为 56 岁,既往有血液学(45%)或乳腺(34%)病史。从细胞毒性暴露到 t-AML 诊断的中位时间为 54.7 个月。在移植时,约 20%的患者有可测量的残留疾病,3%的患者未完全缓解。中位随访时间为 21.4 个月(Q1-Q3,5.9-52.8)。在 12 个月时,总生存率(OS)、无事件生存率(EFS)和移植物抗宿主病(GVHD)-无复发生存率(GRFS)分别为 60.7%(95%CI 54.6-67.5)、52.8%(95%CI 46.5-68.4)和 44.1%(95%CI 37.6-51.8)。在 5 年时,OS、EFS 和 GRFS 分别为 44.1%(95%CI 37.4-52.1)、40.4%(95%CI 33.9-48.1)和 35.3%(95%CI 28.8-43.3)。在最后一次随访时,44%的患者处于完全缓解状态(n=96),移植相关死亡率占所有死亡人数的 21%(n=119)。多变量分析显示,移植时未控制的 t-AML 与较低的 EFS 相关(HR 1.94,95%CI 1.0-3.7,p=0.041)。总之,alloHSCT 治疗 t-AML 显示出令人鼓舞的结果,并随着新型预处理治疗方法的出现提供了额外的机会。

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