Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA.
Department of Pediatrics, University of Washington, Seattle, WA, USA.
Ann Hematol. 2024 Sep;103(9):3737-3743. doi: 10.1007/s00277-024-05774-0. Epub 2024 Jul 14.
With advancements in novel therapeutics, it is unclear whether third hematopoietic cell transplantation (HCT3) has a place in the treatment of recurrent hematopoietic malignancies. We evaluated patients with hematologic malignancies who underwent HCT3 between 2000-2020. Nine patients, with a median age of 18 (9-68) years at HCT3 with acute myelogenous leukemia (n = 5), acute lymphoblastic leukemia (n = 2), myelodysplastic syndrome (n = 1), or undifferentiated acute leukemia (n = 1), were identified. The median time between first HCT and HCT3 was 3.9 (0.7-13.6) years. Indication for HCT3 was relapse (n = 8) or graft failure (n = 1) after second HCT. At HCT3, seven of nine patients were in complete remission by flow cytometry. All experienced robust donor engraftment by one month after HCT3 (≥ 90% CD3) while one died at day + 24 of multi-organ failure and was not evaluable for chimerism. In total, eight patients died from relapse (n = 4), non-relapse, (n = 3) or unknown (n = 1) causes at a median of 0.6 (range, 0.1 - 9.9) years after HCT3. After HCT3, estimated overall survival at 6 months, 1 year, and 5 years was 88%, 63%, and 22%, respectively. In this highly selected group, HCT3 provided a treatment option although long-term survival was still dismal.
随着新型治疗方法的进步，第三次造血细胞移植（HCT3）在治疗复发性血液恶性肿瘤中的地位尚不清楚。我们评估了 2000-2020 年间接受 HCT3 的血液恶性肿瘤患者。共确定了 9 例患者，HCT3 时的中位年龄为 18 岁（9-68 岁），包括急性髓细胞性白血病（n=5）、急性淋巴细胞性白血病（n=2）、骨髓增生异常综合征（n=1）或未分化急性白血病（n=1）。第一次 HCT 与 HCT3 之间的中位时间为 3.9 年（0.7-13.6 年）。HCT3 的适应证为第二次 HCT 后复发（n=8）或移植物失败（n=1）。在 HCT3 时，9 例中有 7 例通过流式细胞术达到完全缓解。所有患者在 HCT3 后一个月内均经历了强烈的供体植入（≥90% CD3），但有 1 例在多器官衰竭第 24 天死亡，无法评估嵌合状态。共有 8 例患者因复发（n=4）、非复发（n=3）或不明原因（n=1）在 HCT3 后中位时间 0.6 年（范围，0.1-9.9 年）死亡。HCT3 后 6 个月、1 年和 5 年的总估计生存率分别为 88%、63%和 22%。在这个高度选择的群体中，HCT3 提供了一种治疗选择，尽管长期生存仍然很差。
