Background: Disease relapse after allogeneic stem cell transplantation (allo-SCT) is the main challenge for curing acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). We investigated the overall survival (OS) after allo-SCT relapse according to different therapeutic approaches. Methods: We analyzed 134 patients who relapsed after allo-SCT performed between 2015 and 2021 at Saint-Antoine University Hospital, Paris and Spedali Civili di Brescia, Brescia. Of these, 103 (77%) were treated, comprising 69/103 (67%) who received therapy in overt relapse and 34/103 (33%) who were treated in a pre-emptive manner when molecular/cytogenetics recurrence or mixed chimerism occurred. The treatment was donor lymphocyte infusion (DLI)-based for 40/103 (39%) patients. Results: The 1-, 2-, and 5-year OS of patients treated with DLI(n= 40) was 67%, 34%, and 34%, respectively, for those treated preventively (n = 20) and 43%, 20%, and 20%, respectively, for those treated in overt relapse (n = 20) (p< 0.01). The 1-, 2-, and 5-year OS of patients treated without DLI (n = 63) was 54%, 40%, and 26%, respectively, for those treated preventively (n = 14) and 17%, 5%, and 0%, respectively, for those treated in overt relapse (n = 49) (p< 0.01). Conclusions: Relapse treatment with a pre-emptive strategy was associated with improved outcomes, particularly when DLI was employed.
背景：异基因干细胞移植（allo-SCT）后疾病复发是治愈急性髓系白血病（AML）和骨髓增生异常综合征（MDS）的主要挑战。本研究旨在探讨不同治疗策略下allo-SCT后复发患者的总生存（OS）情况。方法：我们分析了2015年至2021年间在巴黎圣安托万大学医院和布雷西亚斯佩达利奇维利医院接受allo-SCT后复发的134例患者。其中103例（77%）接受了治疗，包括69/103例（67%）在显性复发时接受治疗，34/103例（33%）在出现分子/细胞遗传学复发或混合嵌合状态时采取抢先治疗。40/103例（39%）患者接受了以供者淋巴细胞输注（DLI）为基础的治疗。结果：在接受DLI治疗的患者（n=40）中，抢先治疗组（n=20）的1年、2年和5年OS分别为67%、34%和34%，而显性复发治疗组（n=20）分别为43%、20%和20%（p<0.01）。在未接受DLI治疗的患者（n=63）中，抢先治疗组（n=14）的1年、2年和5年OS分别为54%、40%和26%，而显性复发治疗组（n=49）分别为17%、5%和0%（p<0.01）。结论：采用抢先治疗策略处理移植后复发与改善预后相关，尤其在联合应用DLI时效果更为显著。
肿瘤(癌症)患者之家