Zhang Haixiao, Guo Wenwen, Wang Jiali, Lu Ni, Zheng Xinhui, Sun Qi, Xia Yonghui, Zhang Rongli, Chen Xin, Ma Qiaoling, Yang Donglin, Pang Aiming, Wei Jialin, He Yi, Feng Sizhou, Han Mingzhe, Zhai Weihua, Jiang Erlie
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China.
Tianjin Institutes of Health Science, Tianjin, 301600, China.
Bone Marrow Transplant. 2024 Dec;59(12):1654-1666. doi: 10.1038/s41409-024-02402-3. Epub 2024 Aug 27.
Bone marrow fibrosis (BMF) of unknown etiology was common in hematological malignancies, but its prognostic value for acute myeloid leukemia (AML) is unclear. We interrogated data from 532 newly diagnosed subjects with AML receiving allogeneic hematological stem cell transplantation to evaluate the prognostic impact of BMF on transplant outcomes. Using the European consensus on the grading of BMF at diagnosis, 255 (48%) subjects were BMF-0, 209 (39%), BMF-1 and 68 (13%), BMF-2-3. Subjects with BMF-2-3 had poor overall survival (P < 0.001), disease-free survival (P < 0.001) and a higher incidence of relapse (CIR, P < 0.001). Multi-variable analyses in subjects achieving pre-transplant complete remission showed BMF-2-3 was an independent risk factor for CIR (Hazard Ratio [HR] = 2.17, (95% CI, 1.11, 4,24); P = 0.02). Furthermore, BMF-2-3 group showed delayed neutrophil and platelet engraftment and delayed B cell recovery post-transplantation. These findings demonstrate the significance of BMF in transplant outcomes and attract more attention to AML with BMF.
病因不明的骨髓纤维化（BMF）在血液系统恶性肿瘤中较为常见，但其对急性髓系白血病（AML）的预后价值尚不清楚。我们分析了532例接受异基因造血干细胞移植的新诊断AML患者的数据，以评估BMF对移植结局的预后影响。根据欧洲关于诊断时BMF分级的共识，255例（48%）患者为BMF-0，209例（39%）为BMF-1，68例（13%）为BMF-2-3。BMF-2-3患者的总生存期（P＜0.001）、无病生存期（P＜0.001）较差，复发率较高（累积复发率，P＜0.001）。对移植前达到完全缓解的患者进行多变量分析显示，BMF-2-3是累积复发率的独立危险因素（风险比[HR]=2.17，（95%可信区间，1.11，4.24）；P=0.02）。此外，BMF-2-3组移植后中性粒细胞和血小板植入延迟，B细胞恢复延迟。这些发现证明了BMF在移植结局中的重要性，并引起了对伴有BMF的AML的更多关注。
