异基因造血干细胞移植前巩固化疗对第一次形态学完全缓解且微小残留病阴性中/高危急性髓系白血病患者预后的影响

Effect of consolidation before allogeneic hematopoietic stem cell transplantation for non-favorable acute myeloid leukemia patients with first complete remisson and negative minimal residual disease

目的探讨异基因造血干细胞移植(allo-HSCT)前巩固化疗对第1次形态学完全缓解且微小残留病阴性(CR1/MRD-)中/高危急性髓系白血病(AML)患者预后的影响。方法对2010年1月至2019年3月在CR1/MRD-状态下接受allo-HSCT的155例中/高危AML(不含急性早幼粒细胞白血病)患者进行回顾性分析。结果全部155例患者中,102例获得CR1/MRD-后接受移植前巩固化疗(巩固组),53例获得CR1/MRD-后直接行allo-HSCT(非巩固组),两组中位年龄分别为39(18~56)岁、38(19~67)岁。巩固组、非巩固组移植后5年总生存率分别为(59.3±7.5)%、(62.2±6.9)%(P=0.919),无复发生存率分别为(53.0±8.9)%、(61.6±7.0)%(P=0.936),累积复发率分别为(21.9±5.4)%、(18.3±6.0)%(P=0.942),非复发死亡率分别为(22.4±4.3)%、(28.4±6.5)%(P=0.464)。多因素分析显示,移植前是否接受巩固化疗及其疗程(<2个/≥2个)对预后无显著影响。结论中/高危AML患者可在获得CR1/MRD-后直接进行allo-HSCT。

Objective To probe the prognostic value of consolidation chemotherapy in nonfavorable acute myeloid leukemia(AML)patients who were candidates for allogeneic hematopoietic stem cell transplantation(allo-HSCT)with first complete remission(CR1)and negative minimal residual disease(MRD-).Methods A retrospective analysis was conducted on 155 patients with non-favorable AML who received allo-HSCT in CR1/MRD-from January 2010 to March 2019.The survival data were compared between patients who received and those not received pre-transplant consolidation chemotherapy.Results A total of 102 patients received pre-transplant consolidation chemotherapy(consolidation group),and 53 cases directly proceeded to allo-HSCT when CR1/MRD-was achieved(nonconsolidation group).The median ages were 39(18-56)years old and 38(19-67)years old,respectively.Five-year post-transplant overall survival[(59.3±7.5)%vs(62.2±6.9)%,P=0.919]and relapse-free survival[(53.0±8.9)%vs(61.6±7.0)%,P=0.936]were not significantly different between the two groups(consolidation vs nonconsolidation).There was a weak relationship between consolidation therapy and cumulative incidence of relapse[consolidation:(21.9±5.4)%vs nonconsolidation:(18.3±6.0)%,P=0.942],as well as non-relapse mortality[consolidation:(22.4±4.3)%vs nonconsolidation:(28.4±6.5)%,P=0.464].Multivariate analysis indicated that pre-transplant consolidation and the consolidation courses(<2 vs≥2 courses)did not have an impact on allo-HSCT outcomes.Conclusion Allo-HSCT for candidate patients without further consolidation when CR1/MRD-was attained was feasible.