Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.
Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.
Clin Transplant. 2024 Jul;38(7):e15396. doi: 10.1111/ctr.15396.
Central nervous system leukemia (CNSL) remains a serious complication in patients with acute myeloid leukemia (AML) and an ambiguous prognostic factor for those receiving allo-geneic hematopoiesis stem cell transplantation (allo-HSCT). It is unknown whether using more sensitive tools, such as multiparameter flow cytometry (MFC), to detect blasts in the cerebrospinal fluid (CSF) would have an impact on outcome.
We retrospectively analyzed the clinical outcomes of 1472 AML patients with or without cytology or MFC positivity in the CSF before transplantation. Abnormal CSF (CSF+) was detected via conventional cytology and MFC in 44 patients at any time after diagnosis. A control group of 175 CSF-normal (CSF-) patients was generated via propensity score matching (PSM) analyses according to sex, age at transplant, and white blood cell count at diagnosis.
Compared to those in the CSF-negative group, the conventional cytology positive and MFC+ groups had comparable 8-year nonrelapse mortality (NRM) (4%, 4%, and 6%, p = 0.82), higher cumulative incidence of relapse (CIR) (14%, 31%, and 32%, p = 0.007), lower leukemia-free survival (LFS) (79%, 63%, and 64%, p = 0.024), and overall survival (OS) (83%, 63%, and 68%, p = 0.021), with no significant differences between the conventional cytology positive and MFC+ groups. Furthermore, multivariate analysis confirmed that CSF involvement was an independent factor affecting OS and LFS.
Our results indicate that pretransplant CSF abnormalities are adverse factors independently affecting OS and LFS after allotransplantation in AML patients.
中枢神经系统白血病（CNSL）仍然是急性髓系白血病（AML）患者的严重并发症，也是接受异基因造血干细胞移植（allo-HSCT）患者预后的一个不确定因素。目前尚不清楚使用更敏感的工具，如多参数流式细胞术（MFC），来检测脑脊液（CSF）中的blasts 是否会对结果产生影响。
我们回顾性分析了 1472 例 AML 患者的临床结果，这些患者在移植前的 CSF 中有或没有细胞学或 MFC 阳性。44 例患者在诊断后的任何时间通过常规细胞学和 MFC 检测到异常 CSF（CSF+）。通过倾向评分匹配（PSM）分析，根据性别、移植时年龄和诊断时白细胞计数，生成了 175 例 CSF 正常（CSF-）患者的对照组。
与 CSF 阴性组相比，常规细胞学阳性和 MFC+组的 8 年非复发死亡率（NRM）相似（4%、4%和 6%，p=0.82），累积复发率（CIR）更高（14%、31%和 32%，p=0.007），无白血病生存率（LFS）更低（79%、63%和 64%，p=0.024），总生存率（OS）更低（83%、63%和 68%，p=0.021），但常规细胞学阳性组和 MFC+组之间无显著差异。此外，多变量分析证实 CSF 受累是影响 OS 和 LFS 的独立因素。
我们的研究结果表明，移植前 CSF 异常是影响 AML 患者 allo-HSCT 后 OS 和 LFS 的不良因素。
