文章：

异基因干细胞移植治疗首诊完全缓解的继发性急性髓系白血病较原发急性髓系白血病疗效更差

Inferior outcome of allogeneic stem cell transplantation for secondary acute myeloid leukemia in first complete remission as compared to de novo acute myeloid leukemia

原文发布日期：2020-03-03

DOI: 10.1038/s41408-020-0296-3

类型: Article

开放获取: 是

英文摘要：

Following chemotherapy, secondary acute myeloid leukemia (sAML), occurring after antecedent hematologic diseases, previous chemotherapy or radiation, has an inferior prognosis compared with de novo AML. To define the outcome of sAML in the context of allogeneic stem cell transplantation (alloSCT), a retrospective, registry-based comparison was performed, including 11,439 patients with de novo and 1325 with sAML. Among transplants in first complete remission (CR1) (n = 8,600), the 3-year cumulative incidence of relapse (RI) and non-relapse mortality (NRM) was 28.5% and 16.4% for de novo, and 35% and 23.4% for sAML. Three-year overall survival (OS), leukemia-free survival (LFS) and Graft-versus-Host Disease/relapse-free survival (GRFS) was 60.8%, 55.1%, and 38.6% for de novo, and 46.7%, 41.6%, and 28.4% for sAML, respectively. In multivariate analysis, sAML was associated with a lower OS (HR = 1.33 [95% CI = 1.21–1.48]; p < 10−5), LFS (HR = 1.32 [95% CI = 1.19–1.45]; p < 10−5) and GRFS (HR = 1.2 [95% CI = 1.1–1.31]; p < 10−4) and higher NRM (HR = 1.37 [95% CI = 1.17–1.59]; p < 10−4) and RI (HR = 1.27 [95% CI = 1.12–1.44]; p < 10−3). Results of the Cox model were confirmed in a matched-pair analysis. In contrast, results did not differ between de novo and sAML after alloSCT in induction failure or relapse. Hence, this analysis identified sAML as an independent risk factor for outcome after alloSCT in CR1.
 

摘要翻译： 

化疗后继发性急性髓系白血病（sAML）指继发于既往血液系统疾病、化疗或放疗后发生的急性髓系白血病，其预后差于原发急性髓系白血病。为明确异基因造血干细胞移植（alloSCT）治疗sAML的结局，我们开展了一项基于登记系统的回顾性对照研究，共纳入11,439例原发急性髓系白血病患者和1,325例sAML患者。在首次完全缓解期（CR1）接受移植的患者（n=8,600）中，原发急性髓系白血病组的3年累积复发率（RI）和非复发死亡率（NRM）分别为28.5%和16.4%，而sAML组分别为35%和23.4%。原发急性髓系白血病组的3年总生存期（OS）、无白血病生存期（LFS）和移植物抗宿主病/无复发生存期（GRFS）分别为60.8%、55.1%和38.6%，而sAML组分别为46.7%、41.6%和28.4%。多变量分析显示，sAML与较低的总生存期（风险比HR=1.33[95%置信区间CI=1.21-1.48]；p<10⁻⁵）、无白血病生存期（HR=1.32[95%CI=1.19-1.45]；p<10⁻⁵）和移植物抗宿主病/无复发生存期（HR=1.2[95%CI=1.1-1.31]；p<10⁻⁴）相关，同时伴有较高的非复发死亡率（HR=1.37[95%CI=1.17-1.59]；p<10⁻⁴）和累积复发率（HR=1.27[95%CI=1.12-1.44]；p<10⁻³）。Cox模型结果在配对分析中得到验证。但值得注意的是，在诱导治疗失败或复发后接受异基因造血干细胞移植的患者中，原发与继发性急性髓系白血病的治疗结果无显著差异。本分析由此证实，sAML是CR1期接受异基因造血干细胞移植患者预后的独立危险因素。

原文链接：

Inferior outcome of allogeneic stem cell transplantation for secondary acute myeloid leukemia in first complete remission as compared to de novo acute myeloid leukemia