Late relapse, beyond 2 years following alloHSCT for AML, is rare. Among the 376 patients allografted for AML in our center between 1990 and 2016, 142 (38%) relapsed. The majority (68%) of relapses occurred during the first year following transplantation. Beyond 2 years after alloHSCT, relapse was observed in 26 patients, representing 6.9% of the whole transplanted cohort and 18.3% of the relapsing patients. Cytogenetics at relapse was available in 21 patients and remained for 15 of them concordant to that at diagnosis. The majority (85.7%) of the patients were in CR prior to transplant. Thirteen patients had grade 1–2 acute GvHD, while 13 other patients had grade 3–4 acute GvHD. None of these patients subsequently developed chronic GvHD. In multivariate analyses, a predictive factor of the absence of relapse 2 years after transplantation was the development of extensive chronic GVHD. Salvage therapy achieved new CR in 77% of these patients. We conclude that late relapse can affect a significant minority of patients allografted for AML, and the intensity of the conditioning regimen does not seem to have an impact on these relapses. Moreover, we were able to show that those patients can receive effective salvage therapy.
急性髓系白血病患者在接受异基因造血干细胞移植后，超过两年的晚期复发较为罕见。本中心于1990年至2016年间共对376例AML患者实施异基因移植，其中142例（38%）出现复发。绝大多数复发（68%）发生在移植后第一年内。移植两年后观察到26例复发，占移植总队列的6.9%，占复发患者的18.3%。其中21例患者可获得复发时的细胞遗传学资料，其中15例与诊断时保持一致。绝大多数患者（85.7%）在移植前处于完全缓解状态。13例患者出现1-2级急性移植物抗宿主病，另有13例患者发生3-4级急性移植物抗宿主病，但均未进展为慢性移植物抗宿主病。多变量分析显示，广泛性慢性移植物抗宿主病的发生是移植两年后不复发的预测因素。挽救治疗使77%的患者获得新的完全缓解。我们的结论表明，晚期复发可影响相当比例的AML移植患者，预处理方案的强度似乎对这些复发无显著影响。此外，研究证实这类患者能够通过挽救治疗获得有效控制。
肿瘤(癌症)患者之家