现代时期慢性淋巴细胞白血病异基因造血移植的结果
Outcomes of allogeneic haemopoietic transplant for chronic lymphocytic leukaemia in the modern era.
作者信息
Barge Luani, Tran Steven, Kennedy Glen, Ritchie David, Gottlieb David, Milliken Sam, Spencer Andrew, Purtill Duncan, Perera Travis, Doocey Richard, Larsen Stephen, Butler Andrew, Bardy Peter, Greenwood Matthew, Durrant Simon, Curley Cameron, Stewart Caroline, Tam Constantine, Balendran Shalini, Di Ciaccio Pietro R, Patil Sushrut, Han Min-Hi, Hamad Nada
机构信息
Department of Haematology, Princess Alexandra Hospital University of Queensland, Brisbane, Queensland, Australia.
Department of Haematology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia.
出版信息
Intern Med J. 2025 Jul;55(7):1105-1113. doi: 10.1111/imj.70050. Epub 2025 May 3.
BACKGROUND
Allogeneic haemopoietic stem cell transplantation (HSCT) is an effective therapy with curative potential for patients with high-risk or relapsed/refractory chronic lymphocytic leukaemia (CLL). There are limited data on the use and outcomes of HSCT in the modern era of CLL treatment.
AIMS
The aim of this study was to examine the use of HSCT performed for CLL in Australia and New Zealand, including patients exposed to pathway inhibitors (PIs) prior to transplant.
METHODS
Data were collected through the Australian and New Zealand Transplant and Cellular Therapy Registry for all patients who underwent HSCT for CLL between January 2009 and December 2018. Transplant outcomes were compared between two 5-year time periods: 2009-2013 and 2014-2018.
RESULTS
Ninety-four patients underwent HSCT during 2009-2013 and 50 during 2014-2018. There was a significant reduction in non-relapse mortality (NRM) from 42% (95% confidence interval (CI): 31-52) to 23% (95% CI: 12-35, P = 0.02) between the periods; however, overall survival (OS), progression-free survival (PFS) and relapse were unchanged. Within the 2014-2018 cohort, 22 patients were PI exposed prior to transplant. At 3 years, these patients demonstrated a median OS of 54% (95% CI: 35-82), PFS of 44% (95% CI: 27-71), NRM of 25% (95% CI: 8-45) and cumulative incidence of relapse of 32% (95% CI: 14-52). In multivariate analysis, only disease in complete remission at the time of HSCT was associated with improved OS (hazard ratio: 2.54, 95% CI: 1.04-6.18).
CONCLUSION
Allogeneic HSCT remains a viable treatment option for select patients with CLL.
背景
异基因造血干细胞移植（HSCT）是一种对高危或复发/难治性慢性淋巴细胞白血病（CLL）患者具有治愈潜力的有效治疗方法。在CLL治疗的现代时代，关于HSCT的使用和结果的数据有限。
目的
本研究的目的是调查在澳大利亚和新西兰为CLL进行的HSCT的使用情况，包括移植前接触通路抑制剂（PI）的患者。
方法
通过澳大利亚和新西兰移植与细胞治疗登记处收集了2009年1月至2018年12月期间所有接受CLL HSCT的患者的数据。比较了两个5年时间段（2009 - 2013年和2014 - 2018年）的移植结果。
结果
2009 - 2013年期间有94例患者接受了HSCT，2014 - 2018年期间有50例。在此期间，非复发死亡率（NRM）从42%（95%置信区间（CI）：31 - 52）显著降低至23%（95% CI：12 - 35，P = 0.02）；然而，总生存期（OS）、无进展生存期（PFS）和复发情况未发生变化。在2014 - 2018年队列中，22例患者在移植前接触过PI。3年时，这些患者的中位OS为54%（95% CI：35 - 82），PFS为44%（95% CI：27 - 71），NRM为25%（95% CI：8 - 45），累积复发率为32%（95% CI：14 - 52）。在多变量分析中，只有HSCT时处于完全缓解期的疾病与改善的OS相关（风险比：2.54，95% CI：1.04 - 6.18）。
结论
异基因HSCT仍然是某些CLL患者可行的治疗选择。
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