Enright H, Davies S M, DeFor T, Shu X, Weisdorf D, Miller W, Ramsay N K, Arthur D, Verfaillie C, Miller J, Kersey J, McGlave P
Department of Medicine, University of Minnesota, Minneapolis, USA.
Blood. 1996 Jul 15;88(2):714-20.
We analyzed the incidence of posttransplant chronic myelogenous leukemia (CML) relapse in 283 consecutive related-donor (n = 177) and unrelated-donor (n = 106) allogeneic transplant recipients. Twenty-two of 165 related-donor recipients with stable or advanced disease at the time of transplant had hematologic relapse of CML following transplant (5-year Kaplan-Meier estimate of relapse, 20%; 95% confidence interval [CI], 11 to 30%). One of 12 patients transplanted in second stable phase following blast crisis also relapsed. Fifteen related-donor transplant recipients relapsed within 5 years of transplant; however, seven relapsed between 5 and 9 years after transplant. Factors independently associated with an increased risk of posttransplant relapse for related-donor recipients included prolonged interval between diagnosis and transplant (relative risk, [RR], 3.81; P = .009) and bone marrow basophilia (RR, 5.62; P = .01). Related-donor recipients with posttransplant chronic graft-versus-host disease (CGVHD) had a decreased risk of relapse (RR, 0.24; P = .005). Only two of 106 unrelated-donor transplant recipients relapsed following transplant (5-year Kaplan-Meier estimate of relapse, 3%; 95% CI, 0% to 7%). When both related- and unrelated-donor recipients were considered, the use of an unrelated donor was independently associated with a decreased risk of relapse (RR, 0.24; P = .07). Twelve of 16 relapsing patients who received further therapy (nine of 13 who underwent second transplant and three of three who received donor leukocyte infusions) remain alive. This analysis shows that relapse, sometimes occurring long after transplant, is an important adverse outcome in allogeneic transplantation for CML. Early transplant, posttransplant CGVHD, and use of an unrelated donor are associated with a reduced incidence of relapse, perhaps due to allogeneic disparities enhancing the graft-versus-leukemia effect.
我们分析了283例连续的亲缘供体（n = 177）和非亲缘供体（n = 106）异基因移植受者移植后慢性粒细胞白血病（CML）复发的发生率。165例移植时病情稳定或进展期的亲缘供体受者中，22例移植后发生CML血液学复发（5年Kaplan-Meier复发估计值为20%；95%置信区间[CI]，11%至30%）。12例在急变期后处于第二个稳定期接受移植的患者中有1例也复发。15例亲缘供体移植受者在移植后5年内复发；然而，7例在移植后5至9年复发。与亲缘供体受者移植后复发风险增加独立相关的因素包括诊断与移植之间的间隔延长（相对风险[RR]，3.81；P = 0.009）和骨髓嗜碱性粒细胞增多（RR，5.62；P = 0.01）。移植后发生慢性移植物抗宿主病（CGVHD）的亲缘供体受者复发风险降低（RR，0.24；P = 0.005）。106例非亲缘供体移植受者中只有2例移植后复发（5年Kaplan-Meier复发估计值为3%；95%CI，0%至7%）。当同时考虑亲缘和非亲缘供体受者时，使用非亲缘供体与复发风险降低独立相关（RR，0.24；P = 0.07）。16例接受进一步治疗的复发患者中有12例存活（13例接受第二次移植的患者中有9例，3例接受供体白细胞输注的患者中有3例）。该分析表明，复发（有时发生在移植后很长时间）是CML异基因移植的一个重要不良结局。早期移植、移植后CGVHD和使用非亲缘供体与复发率降低相关，这可能是由于同种异体差异增强了移植物抗白血病效应。
