Konishi Hiroaki, Tachibana Takayoshi, Arai Shota, Izumi Akihiko, Takeda Takaaki, Hirose Natsuki, Nukui Jun, Sato Shuku, Suzuki Taisei, Ishii Ryuji, Yamazaki Etsuko, Matsunawa Manabu, Mukae Junichi, Takahata Atsushi, Tanaka Masatsugu, Suzuki Takahiro, Nakajima Hideaki
Department of Hematology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-Ku, Yokohama, 241-8515, Japan.
Department of Hematology, Kitasato University School of Medicine, Sagamihara, Japan.
Int J Hematol. 2025 May 23. doi: 10.1007/s12185-025-04009-w.
This study aimed to compare the efficacy and safety of preemptive and maintenance therapies as post-transplant therapy for acute myeloid leukemia (AML). Patients with AML who underwent allogeneic stem cell transplantation and received post-transplant therapy were eligible. Preemptive therapy was initiated if elevated Wilms' tumor-1 mRNA was detected in the peripheral blood. Twenty-nine patients received either preemptive (n = 12) or maintenance therapy (n = 17). The median age was 56 years (range, 18-70). The median time from transplantation to intervention was 77 days (range, 43-203) for maintenance and 346 days (range, 104-1027) for preemptive therapy. Maintenance therapy consisted of azacitidine (AZA) monotherapy in six patients, venetoclax (VEN) + AZA in five, and VEN + cytarabine (AraC) in six. Preemptive therapy consisted of AZA monotherapy in two patients, VEN + AZA in nine, and VEN + AraC in one. One-year overall survival from intervention was 92% for maintenance and 73% for preemptive therapy (P = 0.28), and 1-year event-free survival was 83% and 66%, respectively (P = 0.29). No serious adverse events or treatment-related mortality were observed in either group. Both therapies were safe and effective in preventing disease relapse. A prospective study comparing these two groups is warranted.
本研究旨在比较抢先治疗和维持治疗作为急性髓系白血病（AML）移植后治疗的疗效和安全性。接受异基因干细胞移植并接受移植后治疗的AML患者符合条件。如果在外周血中检测到肾母细胞瘤-1 mRNA升高，则开始抢先治疗。29例患者接受了抢先治疗（n = 12）或维持治疗（n = 17）。中位年龄为56岁（范围18 - 70岁）。维持治疗从移植到干预的中位时间为77天（范围43 - 203天），抢先治疗为346天（范围104 - 1027天）。维持治疗包括6例患者接受阿扎胞苷（AZA）单药治疗，5例接受维奈克拉（VEN）+ AZA，6例接受VEN + 阿糖胞苷（AraC）。抢先治疗包括2例患者接受AZA单药治疗，9例接受VEN + AZA，1例接受VEN + AraC。从干预开始的1年总生存率，维持治疗为92%，抢先治疗为73%（P = 0.28），1年无事件生存率分别为83%和66%（P = 0.29）。两组均未观察到严重不良事件或治疗相关死亡。两种治疗在预防疾病复发方面均安全有效。有必要进行一项比较这两组的前瞻性研究。
