文章：

治疗相关急性髓系白血病：大型AML患者队列中强化与非强化治疗的长期结局

Therapy-related AML: long-term outcome in a large cohort of AML-patients with intensive and non-intensive therapy

原文发布日期：2024-09-16

DOI: 10.1038/s41408-024-01140-5

类型: Article

开放获取: 是

英文摘要：

Therapy-related acute myeloid leukemia (t-AML) often exhibits adverse (genetic) features. There is ongoing discussion on the impact of t-AML on long-term outcome in AML. Therefore, we retrospectively analyzed clinical and biological characteristics of 1133 AML patients (225 t-AML patients and 908 de novo AML patients) with a median follow-up of 81.8 months. T-AML patients showed more adverse genetic alterations, higher age and more comorbidities as compared to de novo AML. Median OS in intensively treated t-AML patients was 13.7 months as compared to 39.4 months in de novo AML (p < 0.001). With non-intensive therapy, OS did not differ significantly (p = 0.394). With intensive therapy, significant differences in favor of de novo AML were observed in the ELN intermediate I/II (p = 0.009) and adverse (p = 0.016) risk groups but not within favorable risk groups (APL p = 0.927, ELN favorable p = 0.714). However, t-AML was no independent risk factor for OS (p = 0.103), RR (p = 0.982) and NRM (p = 0.320) in the multivariate analysis. A limitation of our study is an ELN 2010 risk stratification due to a lack of more comprehensive molecular data according to ELN 2022. We conclude that therapeutic algorithms in t-AML, in particular with regard to allo-HSCT, should be guided by ELN genetic risk rather than classification as t-AML alone. Our data support the WHO and ICC 2022 classifications, which include t-AML as diagnostic qualifier rather than a separate subcategory.
 

摘要翻译： 

治疗相关急性髓系白血病（t-AML）常表现出不良（遗传学）特征。关于t-AML对AML长期预后的影响目前仍存在争议。为此，我们回顾性分析了1133例AML患者（包括225例t-AML患者和908例原发AML患者）的临床与生物学特征，中位随访时间为81.8个月。与原发AML相比，t-AML患者具有更多不良遗传学改变、更高年龄和更多合并症。接受强化治疗的t-AML患者中位总生存期为13.7个月，而原发AML患者为39.4个月（p < 0.001）。在非强化治疗组中，总生存期无显著差异（p = 0.394）。强化治疗中，欧洲白血病网中危I/II组（p = 0.009）和高危组（p = 0.016）均显示原发AML显著优于t-AML，但在低危组中无显著差异（急性早幼粒细胞白血病p = 0.927，欧洲白血病网低危组p = 0.714）。多变量分析显示，t-AML并非总生存期（p = 0.103）、缓解率（p = 0.982）和非复发死亡率（p = 0.320）的独立危险因素。本研究的局限性在于采用欧洲白血病网2010风险分层，因缺乏符合欧洲白血病网2022标准的更全面分子数据。我们认为t-AML的治疗策略（尤其在异基因造血干细胞移植方面）应依据欧洲白血病网遗传学风险而非单纯t-AML分类制定。我们的数据支持世界卫生组织和国际共识分类2022版将t-AML作为诊断标识符而非独立亚类的分类方式。

原文链接：

Therapy-related AML: long-term outcome in a large cohort of AML-patients with intensive and non-intensive therapy