Department of Hematology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; Anhui Provincial Key Laboratory of Blood Research and Applications, Hefei, Anhui, China; Division of Life Sciences and Medicine, Blood and Cell Therapy Institute, University of Science and Technology of China, Hefei, Anhui, China.
Department of Hematology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
Transplant Cell Ther. 2024 Oct;30(10):1029.e1-1029.e10. doi: 10.1016/j.jtct.2024.08.004. Epub 2024 Aug 5.
Recent evidence has indicated that measurable residual disease (MRD) markedly affects the prognosis of patients with acute leukemia post-transplantation. However, the prognostic relevance of complete remission with incomplete count recovery (CRi) before transplantation has not been extensively explored. In this single-center, longitudinal study, we assessed the outcomes of 466 MRD-negative acute leukemia patients who underwent single-unit unrelated cord blood transplantation (sUCBT), including 117 patients with CRi. We observed that acute myeloid leukemia (AML) patients with CRi had a significantly lower cumulative incidence of both neutrophil (90.8% versus 96.5%) and platelet engraftment (67.2% versus 85.3%) and experienced increased transplant-related mortality (TRM) (100-day TRM: 14.2% versus 5.3%; 1-year TRM: 20.6% versus 11.3%; P = .024 and .063, respectively), mainly due to infection-related deaths, compared to those in complete remission (CR). Multivariate analysis revealed that CRi was an independent adverse predictor of both neutrophil and platelet engraftment and increased 100-day TRM in AML patients. However, CRi status did not affect relapse or reduce 5-year overall survival (OS), leukemia-free survival (LFS), or GVHD-free relapse-free survival (GRFS) in the AML cohort. Conversely, for patients with acute lymphoblastic leukemia (ALL), CRi did not impact engraftment, TRM, relapse or survival after sUCBT. Our findings underscore that CRi status before sUCBT portends poorer engraftment outcomes and a greater TRM in AML patients, although it does not significantly affect the prognosis of ALL patients.
最近的证据表明，移植后可测量的残留疾病（MRD）显著影响急性白血病患者的预后。然而，移植前完全缓解伴不完全计数恢复（CRi）的预后相关性尚未得到广泛探讨。在这项单中心、纵向研究中，我们评估了 466 例 MRD 阴性急性白血病患者接受单份无关脐带血移植（sUCBT）的结果，其中包括 117 例 CRi 患者。我们观察到，CRi 的急性髓系白血病（AML）患者中性粒细胞（90.8%比 96.5%）和血小板植入（67.2%比 85.3%）的累积发生率明显较低，且移植相关死亡率（TRM）增加（100 天 TRM：14.2%比 5.3%；1 年 TRM：20.6%比 11.3%；P=0.024 和 0.063），主要是由于感染相关死亡，与完全缓解（CR）患者相比。多变量分析显示，CRi 是 AML 患者中性粒细胞和血小板植入以及 100 天 TRM 的独立不良预测因子。然而，CRi 状态并不影响复发或降低 AML 患者的 5 年总生存率（OS）、无白血病生存率（LFS）或无 GVHD 无复发生存率（GRFS）。相反，对于急性淋巴细胞白血病（ALL）患者，CRi 并不影响 sUCBT 后的植入、TRM、复发或生存。我们的研究结果强调，sUCBT 前的 CRi 状态预示着 AML 患者植入结果较差和 TRM 较高，尽管它对 ALL 患者的预后没有显著影响。
