Wang Mingyang, Chen Shulian, Zhang Qiuqiu, Yuan Linyu, Wang Xue, Zhang Junshi, Zhang Xiaoyu, Cao Yigeng, Li Dongmei, Lu Xinxiao, Wang Meijiao, Jiang Xiaosi, Zhang Rongli, Chen Xin, Ma Qiaoling, Wei Jialin, Yang Donglin, He Yi, Pang Aiming, Feng Sizhou, Han Mingzhe, Zhai Weihua, Zhao Xingli, Jiang Erlie
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China.
Department of Hematology, Oncology Center, Tianjin Union Medical Center of Nankai University, Tianjin, China.
Front Immunol. 2025 Jan 8;15:1511057. doi: 10.3389/fimmu.2024.1511057. eCollection 2024.
Hematopoietic stem cell transplantation (HSCT) and chemotherapy are considered potentially curative options for post-remission therapy in acute myeloid leukemia (AML). However, the comparative effectiveness of these approaches in favorable- and intermediate-risk AML remains unclear and requires further investigation.
In this retrospective study, 111 patients diagnosed with de novo favorable- and intermediate-risk AML, categorized according to the ELN 2022 guidelines, were investigated to compare outcomes following autologous HSCT (auto-HSCT), matched sibling donor HSCT (MSD-HSCT), and chemotherapy. Through propensity score matching for disease status before HSCT, 42 cases in first complete remission were selected for each of the auto-HSCT group and the MSD-HSCT group. Additionally, 27 cases in the chemotherapy group, excluding patients with early relapse or death, were included for comparison.
In the overall population, the 3-year overall survival (OS) rates were 85.7%, 83.1%, and 70.4% (p = 0.043), while the disease-free survival (DFS) rates were 78.6%, 83.2%, and 57.1% (p = 0.002) in the auto-HSCT, MSD-HSCT, and chemotherapy groups, respectively. Notably, both auto-HSCT and MSD-HSCT demonstrated significantly improved DFS compared to chemotherapy in patients with favorable-risk AML. Multivariate analysis further revealed that chemotherapy was significantly associated with inferior DFS compared to auto-HSCT (HR=2.82; 95% CI, 1.26-6.32, p=0.012), while DFS was similar between the MSD-HSCT and auto-HSCT groups (HR=0.80; 95% CI, 0.31-2.09, p=0.645).
The findings suggested the advantages of both MSD-HSCT and auto-HSCT over chemotherapy as post-remission therapy for AML patients with favorable and intermediate risk. Further research is needed to support these conclusions.
造血干细胞移植（HSCT）和化疗被认为是急性髓系白血病（AML）缓解后治疗的潜在治愈选择。然而，这些方法在低危和中危AML中的相对有效性仍不明确，需要进一步研究。
在这项回顾性研究中，根据ELN 2022指南对111例诊断为初发低危和中危AML的患者进行了调查，以比较自体HSCT（auto-HSCT）、同胞全相合供者HSCT（MSD-HSCT）和化疗后的结果。通过对HSCT前疾病状态进行倾向评分匹配，auto-HSCT组和MSD-HSCT组各选择了42例首次完全缓解的患者。此外，化疗组纳入了27例排除早期复发或死亡患者进行比较。
在总体人群中，auto-HSCT组、MSD-HSCT组和化疗组的3年总生存率（OS）分别为85.7%、83.1%和70.4%（p = 0.043），无病生存率（DFS）分别为78.6%、83.2%和57.1%（p = 0.002）。值得注意的是，在低危AML患者中，auto-HSCT和MSD-HSCT的DFS均显著优于化疗。多因素分析进一步显示，与auto-HSCT相比，化疗与较差的DFS显著相关（HR=2.82；95%CI，1.26-6.32，p=0.012），而MSD-HSCT组和auto-HSCT组之间的DFS相似（HR=0.80；95%CI，0.31-2.09，p=0.645）。
研究结果表明，MSD-HSCT和auto-HSCT作为低危和中危AML患者缓解后治疗均优于化疗。需要进一步研究来支持这些结论。
