Larue Marion, Labopin Myriam, Schroeder Thomas, Huang Xiao-Jun, Blau Igor W, Schetelig Johannes, Ganser Arnold, Hamladji Rose-Marie, Bethge Wolfgang, Kröger Nicolaus, Socié Gerard, Salmenniemi Urpu, Sengeloev Henrik, Dholaria Bhagirathbhai, Savani Bipin N, Nagler Arnon, Ciceri Fabio, Mohty Mohamad
Hematology Department Hôpital Saint-Antoine, APHP Paris France.
INSERM UMRs 938 Sorbonne University Paris France.
Hemasphere. 2024 Oct 22;8(10):e70026. doi: 10.1002/hem3.70026. eCollection 2024 Oct.
Information on late complications in patients with acute leukemia who have undergone allogeneic hematopoietic cell transplantation (HCT) is limited. We performed a left-truncated analysis of long-term survival in patients with acute leukemia who were alive and disease-free 2 years after HCT. We included 2701 patients with acute lymphoblastic leukemia (ALL) and 9027 patients with acute myeloid leukemia (AML) who underwent HCT between 2005 and 2012. The 10-year overall survival (OS) rate was 81.3% for ALL and 76.2% for AML, with the main causes of late mortality being relapse (ALL-33.9%, AML-44.9%) and chronic graft-versus-host disease (ALL-29%, AML-18%). At 10 years, HCT-related mortality was 16.8% and 20.4%, respectively. Older age and unrelated donor transplantation were associated with a worse prognosis for both types of leukemia. In addition, transplantation in the second or third complete remission and peripheral blood HSC for ALL are associated with worse outcomes. Similarly, adverse cytogenetics, female donor to male patient combination, and reduced intensity conditioning in AML contribute to poor prognosis. We conclude that 2-year survival in remission after HCT for acute leukemia is encouraging, with OS of nearly 80% at 10 years. However, the long-term mortality risk of HCT survivors remains significantly higher than that of the age-matched general population. These findings underscore the importance of tailoring transplantation strategies to improve long-term outcomes in patients with acute leukemia undergoing HCT.
关于接受异基因造血细胞移植（HCT）的急性白血病患者晚期并发症的信息有限。我们对HCT后2年存活且无疾病的急性白血病患者的长期生存进行了左截断分析。我们纳入了2005年至2012年间接受HCT的2701例急性淋巴细胞白血病（ALL）患者和9027例急性髓细胞白血病（AML）患者。ALL的10年总生存率（OS）为81.3%，AML为76.2%，晚期死亡的主要原因是复发（ALL为33.9%，AML为44.9%）和慢性移植物抗宿主病（ALL为29%，AML为18%）。10年时，HCT相关死亡率分别为16.8%和20.4%。年龄较大和无关供体移植与两种类型白血病的预后较差相关。此外，ALL在第二次或第三次完全缓解期进行移植以及使用外周血造血干细胞移植的预后较差。同样，AML中不良细胞遗传学、女性供体与男性患者的组合以及减低强度预处理也会导致预后不良。我们得出结论，急性白血病HCT后2年缓解期生存情况令人鼓舞，10年OS接近80%。然而，HCT幸存者的长期死亡风险仍显著高于年龄匹配的一般人群。这些发现强调了调整移植策略以改善接受HCT的急性白血病患者长期预后的重要性。
