Primary induction failure (PIF) in acute myeloid leukemia (AML) patients is associated with poor outcome, with allogeneic hematopoietic stem cell transplantation (HCT) being the sole curative therapeutic option. Here, we retrospectively evaluated long-term outcomes of 220 AML patients undergoing allogeneic HCT after PIF who never achieved remission, and identified clinical and molecular risk factors associated with treatment response and ultimate prognosis. In this high-risk population, disease-free survival was 25.2% after 5 years and 18.7% after 10 years, while overall survival rates were 29.8% and 21.6% after 5 and 10 years of HCT, respectively. 10-year non-relapse mortality was 32.5%, and 48.8% of patients showed disease relapse within 10 years after allogeneic HCT. Adverse molecular risk features determined at initial diagnosis, poor performance status at the time of allogeneic HCT, and long diagnosis-to-HCT intervals were associated with unfavorable prognosis. Collectively, our data suggests that immediate allogeneic HCT after PIF offers long-term survival and cure in a substantial subset of cases and that high-risk AML patients who never achieved complete response during induction might benefit from early donor search.
急性髓系白血病（AML）患者的原发性诱导失败（PIF）与不良预后相关，异基因造血干细胞移植（HCT）是唯一的治愈性治疗选择。在此，我们回顾性评估了220例在PIF后接受异基因HCT但从未达到缓解的AML患者的长期结局，并确定了与治疗反应和最终预后相关的临床和分子风险因素。在这个高危人群中，无病生存率在5年后为25.2%，10年后为18.7%；而总生存率在HCT后5年和10年分别为29.8%和21.6%。10年非复发死亡率为32.5%，48.8%的患者在异基因HCT后10年内出现疾病复发。在初始诊断时确定的不良分子风险特征、异基因HCT时的体能状态差以及诊断至移植间隔时间长均与不良预后相关。总体而言，我们的数据表明，PIF后立即进行异基因HCT在相当一部分病例中提供了长期生存和治愈，且诱导期间从未达到完全缓解的高危AML患者可能受益于早期供体搜索。
肿瘤(癌症)患者之家