自体干细胞移植用于无检测到残留微小疾病的首次完全缓解的中风险成人急性髓性白血病患者。与EBMT的全球委员会和ALWP进行的半合相移植的一项比较性回顾性研究。
Autologous stem cell transplantation in adult patients with intermediate-risk acute myeloid leukemia in first complete remission and no detectable minimal residual disease. A comparative retrospective study with haploidentical transplants of the global committee and the ALWP of the EBMT.
发表日期：2023 Aug 28
作者：
Jia Chen, Myriam Labopin, Thomas Pabst, Xi Zhang, Erlie Jiang, Alessandra Tucci, Jan Cornelissen, Ellen Meijer, Irma Khevelidze, Emmanuelle Polge, Depei Wu, Mohamad Mohty, Norbert-Claude Gorin
来源：
Stem Cell Research & Therapy
摘要：
在第一缓解（CR1）期间没有可测量残余疾病（MRD阴性）的中等风险（IR）急性髓系白血病（AML）患者中，对于最佳巩固治疗的选择存在争议。分析了来自196个中心的1122名成年患者在2010年至2021年接受的移植治疗：547名接受了自体干细胞移植（ASCT），575名接受了半相合供体移植。由于显著的相互作用，针对野生型FLT3（FLT3-wt）和FLT3-ITD突变（FLT3-ITD）的患者分别进行比较。在FLT3-wt患者中，半相合移植的复发率（RI）较低两年（16.9%对32.6%；HR = 0.40，p < 0.001），非疾病相关死亡（NRM）较高（17.2%对3.5%；HR = 7.02，p < 0.001），存活无病生存（LFS）相似（65.9%对63.8%；p = 0.37），总生存（OS）较低（73.2%对80.6%；HR = 1.69，p = 0.018）。在FLT3-ITD患者中，半相合移植的复发率较低两年（8.2%对47.8%；HR = 0.14，p < 0.001），NRM较高（20.2%对5.6%；HR = 3.43，p = 0.002），LFS较好（71.5%对46.6%；HR = 0.53，p = 0.007），OS相似（73.5%对61.9%；p = 0.44）。在MRD阴性CR1的FLT3-wt IR AML患者中，自体干细胞移植是一个有效的选择，而在FLT3-ITD患者中，半相合移植效果更好。自体移植与化疗在FLT3-wt患者中的优越性以及FLT3抑制剂的维持治疗作用仍待研究。© 2023. 作者。
In patients with acute myeloid leukemia (AML) of intermediate-risk (IR) in first remission (CR1) with no measurable residual disease (MRD negative), the choice of the best consolidation is questionable. 1122 adult patients from 196 centers, transplanted in 2010-21 were analyzed: 547 received an autologous stem cell transplantation (ASCT) and 575 a Haploidentical donor transplant. Because of a significant interaction, comparisons were done separately for patients with wild-type FLT3 (FLT3-wt) and FLT3-ITD mutation (FLT3-ITD). In FLT3-wt patients, haploidentical transplants had two year lower relapse incidence (RI) (16.9% versus 32.6%; HR = 0.40, p < 0.001), higher NRM higher (17.2% vs 3.5%; HR = 7.02, p < 0.001), similar LFS (65.9% vs 63.8%; p = 0.37) and lower OS (73.2% vs 80.6%; HR = 1.69, p = 0.018). In FLT3-ITD patients, haploidentical transplants had two year lower RI (8.2% vs 47.8%; HR = 0.14, p < 0.001) higher NRM (20.2% vs 5.6%; HR = 3.43, p = 0.002), better LFS (71.5% vs 46.6%; HR = 0.53, p = 0.007) and similar OS (73.5% vs 61.9%; p = 0.44). In IR AML patients with FLT3-wt in MRD negative CR1, autologous stem cell transplantation is a valid option, while in patients with FLT3-ITD, haploidentical transplant is better. Whether autologous transplantation is superior to chemotherapy in FLT3-wt patients and the role of maintenance therapy with FLT3 inhibitors remain to be studied.© 2023. The Author(s).