文章：

首次移植后复发的AML患者接受第二次异基因造血干细胞移植的供者选择：EBMT急性白血病工作组研究

Donor selection for a second allogeneic stem cell transplantation in AML patients relapsing after a first transplant: a study of the Acute Leukemia Working Party of EBMT

原文发布日期：2019-11-18

DOI: 10.1038/s41408-019-0251-3

类型: Article

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英文摘要：

Second allogeneic stem-cell transplantation (SCT2) is a therapeutic option for patients with AML relapsing after a first transplant. Prior studies have shown similar results after SCT2 from the same or different donor; however, there are limited data on second non-T-depleted haplo-identical transplant in this setting. We retrospectively analyzed SCT2 outcomes in 556 patients, median age 46 years, relapsing after first transplant given in CR1. Patients were divided into three groups based on SCT2 donor (donor2): same donor (n = 163, sib/sib-112, UD/UD-51), different matched donor (n = 305, sib/different sib-44, sib/UD-93, UD/different UD-168), or haplo-donor (n = 88, sib/haplo-45, UD/haplo-43). Two-year leukemia-free survival (LFS) rate after SCT2 was 23.5%, 23.7%, and 21.8%, respectively (P = 0.30). Multivariate analysis showed no effect of donor2 type on relapse: hazard ratio (HR) 0.89 (P = 0.57) and 1.11 (P = 0.68) for different donor and haplo-donor compared to same donor, respectively. However, donor2 did predict for non-relapse mortality (NRM) after SCT2: HR 1.21 (P = 0.50) and 2.08 (P = 0.03), respectively, and for LFS: HR 1.00 (P = 0.97) and 1.43 (P = 0.07), respectively. In conclusion, SCT2 with the same or different matched donor is associated with similar outcomes in patients with relapsed AML. Non-T-depleted haplo-identical transplant may be associated with higher NRM, similar relapse rate and with no better results in this setting.
 

摘要翻译： 

第二次异基因干细胞移植（SCT2）是针对首次移植后复发的急性髓系白血病（AML）患者的一种治疗选择。先前的研究显示，使用相同或不同供者的SCT2后结果相似；然而，关于第二次非T细胞去除的单倍体相合移植在这种情况下的数据有限。我们回顾性分析了556例患者SCT2的结果，这些患者中位年龄46岁，在首次移植（于CR1期进行）后复发。根据SCT2供者（供者2）将患者分为三组：相同供者（n=163，同胞/同胞-112，无关供者/无关供者-51）、不同匹配供者（n=305，同胞/不同同胞-44，同胞/无关供者-93，无关供者/不同无关供者-168）或单倍体相合供者（n=88，同胞/单倍体-45，无关供者/单倍体-43）。SCT2后两年无白血病生存（LFS）率分别为23.5%、23.7%和21.8%（P=0.30）。多变量分析显示供者2类型对复发无影响：与相同供者相比，不同供者和单倍体相合供者的风险比（HR）分别为0.89（P=0.57）和1.11（P=0.68）。然而，供者2确实预测了SCT2后的非复发死亡率（NRM）：风险比分别为1.21（P=0.50）和2.08（P=0.03），以及对于LFS：风险比分别为1.00（P=0.97）和1.43（P=0.07）。总之，对于复发的AML患者，使用相同或不同匹配供者的SCT2与相似的结果相关。非T细胞去除的单倍体相合移植可能与较高的NRM、相似的复发率相关，并且在这种背景下没有更好的结果。

原文链接：

Donor selection for a second allogeneic stem cell transplantation in AML patients relapsing after a first transplant: a study of the Acute Leukemia Working Party of EBMT