急性髓系白血病患者异基因移植后的生存情况，根据移植前微小残留病和预处理强度划分
Survival after allogeneic transplantation according to pretransplant minimal residual disease and conditioning intensity in patients with acute myeloid leukemia.
作者信息
Núñez-Torrón Stock Claudia, Jiménez Chillón Carlos, Martín Moro Fernando, Marquet Palomanes Juan, Piris Villaespesa Miguel, Roldán Santiago Ernesto, Rodríguez Martín Eulalia, Chinea Rodríguez Anabelle, García Gutiérrez Valentín, Moreno Jiménez Gemma, López Jiménez Javier, Herrera Puente Pilar
机构信息
Departamento de Hematología y Hemoterapia, Hospital Universitario Infanta Sofía, Madrid, Spain.
Medicine and Medical Specialties Department, Universidad Alcalá de Henares, Madrid, Spain.
出版信息
Front Oncol. 2024 May 2;14:1394648. doi: 10.3389/fonc.2024.1394648. eCollection 2024.
BACKGROUND
The measurement of minimal residual disease (MRD) by multiparametric flow cytometry (MFC) before hematopoietic stem cell transplantation (HSCT) in patients with acute myeloid leukemia (AML) is a powerful prognostic factor. The interaction of pretransplant MRD and the conditioning intensity has not yet been clarified.
OBJECTIVE
The aim of this study is to analyze the transplant outcomes of patients with AML who underwent HSCT in complete remission (CR), comparing patients with positive MRD (MRD+) and negative MRD (MRD-) before HSCT, and the interaction between conditioning intensity and pre-HSCT MRD.
STUDY DESIGN
We retrospectively analyzed the transplant outcomes of 118 patients with AML who underwent HSCT in CR in a single institution, comparing patients with MRD+ and MRD- before HSCT using a cutoff of 0.1% on MFC, and the interaction between conditioning intensity and pre-HSCT MRD.
RESULTS
Patients with MRD+ before HSCT had a significantly worse 2-year (2y) event-free survival (EFS) (56.5% vs. 32.0%, = 0.018) than MRD- patients, due to a higher cumulative incidence of relapse (CIR) at 2 years (49.0% vs. 18.0%, = 0.002), with no differences in transplant-related mortality (TRM) (2y-TRM, 19.0% and 25.0%, respectively, = 0.588). In the analysis stratified by conditioning intensity, in patients who received MAC, those with MRD- before HSCT had better EFS ( = 0.009) and overall survival (OS) ( = 0.070) due to lower CIR ( = 0.004) than MRD+ patients. On the other hand, the survival was similar in reduced intensity conditioning (RIC) patients regardless of the MRD status.
CONCLUSIONS
Patients with MRD+ before HSCT have worse outcomes than MRD- patients. In patients who received MAC, MRD- patients have better EFS and OS due to lower CIR than MRD+ patients, probably because they represent a more chemo-sensitive group. However, among RIC patients, results were similar regardless of the MRD status.
背景
在急性髓系白血病（AML）患者造血干细胞移植（HSCT）前，通过多参数流式细胞术（MFC）检测微小残留病（MRD）是一个强有力的预后因素。移植前MRD与预处理强度之间的相互作用尚未阐明。
目的
本研究旨在分析处于完全缓解（CR）状态下接受HSCT的AML患者的移植结局，比较HSCT前MRD阳性（MRD+）和阴性（MRD-）的患者，以及预处理强度与HSCT前MRD之间的相互作用。
研究设计
我们回顾性分析了在单一机构中118例处于CR状态下接受HSCT的AML患者的移植结局，使用MFC检测值0.1%作为临界值比较HSCT前MRD+和MRD-的患者，以及预处理强度与HSCT前MRD之间的相互作用。
结果
HSCT前MRD+的患者2年无事件生存期（EFS）显著低于MRD-的患者（56.5%对32.0%，P = 0.018），这是由于2年时更高的复发累积发生率（CIR）（49.0%对18.0%，P = 0.002），而移植相关死亡率（TRM）无差异（2年TRM分别为19.0%和25.0%，P = 0.588）。在按预处理强度分层的分析中，在接受大剂量化疗（MAC）的患者中，HSCT前MRD-的患者由于CIR较低（P = 0.004），其EFS（P = 0.009）和总生存期（OS）（P = 0.070）优于MRD+的患者。另一方面，在接受减低强度预处理（RIC）的患者中，无论MRD状态如何，生存率相似。
结论
HSCT前MRD+的患者结局比MRD-的患者差。在接受MAC的患者中，MRD-的患者由于CIR较低，其EFS和OS优于MRD+的患者，可能是因为他们代表了化疗更敏感的群体。然而，在RIC患者中，无论MRD状态如何，结果相似。
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