摘要
目的 探讨成人继发急性髓系白血病(AML)接受异基因造血干细胞移植(allo-HSCT)的疗效及预后影响因素.方法 多中心回顾性临床研究.纳入2014年1月至2022年11月因继发AML在浙江省造血干细胞移植协作组4个中心接受allo-HSCT的18岁以上的成人患者,并进行疗效及预后影响因素分析.结果 共纳入95例患者,其中66例(69.5％)为骨髓增生异常综合征(MDS)转化AML(MDS-AML),4 例(4.2％)为 MDS/骨髓增殖性肿瘤(MPN)转化 AML(MDS/MPN-AML),25 例(26.3％)为治疗相关AML(tAML).所有患者的3年累积复发率(CIR)、无白血病生存(LFS)率和总生存(OS)率分别为 18.6％(95％CI 10.2％～27.0％)、70.6％(95％CI60.8％～80.4％)和73.3％(95％CI 63.9％～82.7％).M-AML(包括MDS-AML、MDS/MPN-AML)组和tAML组的3年CIR分别为20.0％和 16.4％(P=0.430);3年LFS率分别为68.3％和75.4％(P=0.176);3年OS率分别为69.7％和75.4％(P=0.233),两组间差异均无统计学意义.TP53突变组和无TP53突变组的3年CIR分别为60.0％和13.7％(P=0.003),3 年 LFS率分别为 20.0％和 76.5％(P=0.002),3 年 OS 率分别为 40.0％和 77.6％(P=0.002).根据2022欧洲白血病网(ELN2022)危险分层,低危、中危和高危3组患者的3年CIR分别为 8.3％、17.8％和 22.6％(P=0.639),3 年 LFS 率分别为 91.7％、69.5％和 65.6％(P=0.268),3 年 OS 率分别为91.7％、71.4％和70.1％(P=0.314).多因素分析表明,移植时疾病未缓解和伴有TP53突变是影响患者CIR、LFS和OS的独立危险因素.结论M-AML组(MDS-AML、MDS/MPN-AML)与tAML组患者allo-HSCT预后相近.移植时疾病未缓解和伴有TP53突变是不良预后因素.ELN2022危险分层对继发AML患者allo-HSCT预后的预测价值有限.
Abstract
Objective To evaluate the efficacy and prognostic factors of allogeneic hematopoietic stem cell transplantation(allo-HSCT)in patients with secondary acute myeloid leukemia(sAML).Methods In this multicenter,retrospective clinical study,adult patients aged ≥18 years who underwent allo-HSCT for sAML at four centers of the Zhejiang Hematopoietic Stem Cell Transplantation Collaborative Group from January 2014 to November 2022 were included,and the efficacy and prognostic factors of allo-HSCT were analyzed.Results A total of 95 patients were enrolled;66(69.5％)had myelodysplastic syndrome-acute myeloid leukemia(MDS-AML),4(4.2％)had MDS/MPN-AML,and 25(26.3％)had therapy-related AML(tAML).The 3-year CIR,LFS,and overall survival(OS)rates were 18.6％(95％CI 10.2％-27.0％),70.6％(95％CI60.8％-80.4％),and 73.3％(95％CI 63.9％-82.7％),respectively.The 3-year CIRs of the M-AML group(including MDS-AML and MDS/MPN-AML)and the tAML group were 20.0％and 16.4％,respectively(P=0.430).The 3-year LFSs were 68.3％and 75.4％,respectively(P=0.176).The 3-year OS rates were 69.7％and 75.4％,respectively(P=0.233).The 3-year CIRs of the groups with and without TP53 mutations were 60.0％and 13.7％,respectively(P=0.003);the 3-year LFSs were 20.0％and 76.5％,respectively(P=0.002);and the 3-year OS rates were 40.0％and 77.6％,respectively(P=0.002).According to European LeukmiaNet 2022(ELN2022)risk stratification,the 3-year CIRs of patients in the low-,intermediate-,and high-risk groups were 8.3％,17.8％,and 22.6％,respectively(P=0.639).The three-year LFSs were 91.7％,69.5％,and 65.6％,respectively(P=0.268).The 3-year OS rates were 91.7％,71.4％,and 70.1％,respectively(P=0.314).Multivariate analysis revealed that advanced disease at allo-HSCT and TP53 mutations were independent risk factors for CIR,LFS,and OS.Conclusion There was no significant difference in the prognosis of patients who underwent allo-HSCT among the MDS-AML,MDS/MPN-AML,and tAML groups.Advanced disease at transplantation and TP53 mutations were poor prognostic factors.ELN2022 risk stratification had limited value for predicting the prognosis of patients with sAML following allo-HSCT.
维普
万方数据