研究动态
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首次缓解期有利风险急性髓系白血病同种异体移植的趋势:从 EBMT 的 ALWP 开始超过 15 年的纵向研究。

Trends in allogeneic transplantation for favorable risk acute myeloid leukemia in first remission: a longitudinal study of >15 years from the ALWP of the EBMT.

发表日期:2024 Aug 20
作者: Arnon Nagler, Myriam Labopin, Urpu Salmenniemi, Depei Wu, Didier Blaise, Alessandro Rambaldi, Péter Reményi, Edouard Forcade, Gérard Socié, Patrice Chevallier, Peter von dem Borne, David Burns, Christoph Schmid, Johan Maertens, Nicolaus Kröger, Gesine Bug, Mahmoud Aljurf, Jan Vydra, Kazimierz Halaburda, Fabio Ciceri, Mohamad Mohty
来源: Burns & Trauma

摘要:

我们在 3 个时间段内评估了 CR1 中有利风险 AML 的同种异体移植 (HSCT) 的结果。纳入1850名患者,2005年至2009年为222名,2010年至2014年为-392名,2015年至2021年为1236名; 526 与 t (8:21)、625 与 inv (16) 以及 699 与 NPM1mutFLT3WT。 2015-2021年移植的患者年龄较大(p<0.0001),其中≥60岁的患者较多(p<0.0001)。 2015-2021 年最常见的诊断是 NPM1mutFLT3WT 与前 2 个时期的 t (8:21) (p < 0001)。单倍体移植 (Haplo) 从 5.9% 增加到 14.5% (p<<0.0001)。与其他两个时期相比,2015-2021 年移植后环磷酰胺 (PTCy) 预防移植物抗宿主病 (GVHD) 的频率更高 (p<0.0001)。多变量分析表明,与 2005-2009 年进行的 HSCT 相比,2015 年以上进行的 HSCT 中慢性 GVHD 的发生率降低,风险比 (HR) = 0.74(95% CI 0.56-0.99,p = 0.046)且无 GVHD,复发与 2005-2009 年移植的患者相比,2010-2014 年移植的患者的无生存期 (GRFS) 有所改善,HR = 0.74 (95% CI 0.56-0.98,p = 0.037)。其他 HSCT 结果没有差异,≥2015 年没有改善。 t (8:21) 患者的 LFS、OS 和 GRFS 较差,HR = 1.32 (95% CI 1.03-1.68,p = 0.026)、HR = 1.38 (95% CI 1.04-1.83,p = 0.027) 和HR = 01.25(95% CI 1.02-1.53​​,p = 0.035)。总之,这项对 16 年以上移植的有利风险 AML 患者进行 HSCT 的回顾性分析显示,来自具有 PTCy 的 Haplo 供体的 ≥60 岁患者的移植数量有所增加。最重要的是,3 年 GRFS 改善≥2010 年,总慢性 GVHD 减少≥2015 年,其他 HSCT 结果没有显着变化。© 2024。作者,获得 Springer Nature Limited 的独家许可。
We assessed outcomes of allogeneic transplantation (HSCT) in favorable risk AML in CR1 over 3 time periods. 1850 patients were included, 2005 to 2009- 222, 2010 to 2014 -392, and 2015 to 2021-1236; 526 with t (8:21), 625 with inv (16), and 699 with NPM1mutFLT3WT. Patients transplanted in 2015-2021 were older (p < 0.0001) with more patients ≥60 years of age (p < 0.0001). The most frequent diagnosis in 2015-2021 was NPM1mutFLT3WT vs. t (8:21) in the 2 earlier periods, (p < 0001). Haploidentical transplants (Haplo) increased from 5.9% to 14.5% (p < 0.0001). Graft-versus-host disease (GVHD) prophylaxis with post-transplant cyclophosphamide (PTCy) was more frequent in 2015-2021 vs. the other 2 periods (p < 0.0001). On multivariate analysis, incidence of total chronic GVHD was reduced in HSCTs performed ≥2015 vs. those performed in 2005-2009, hazard ratio (HR) = 0.74 (95% CI 0.56-0.99, p = 0.046) and GVHD-free, relapse-free survival (GRFS) improved for patients transplanted from 2010-2014 vs. those transplanted in 2005-2009, HR = 0.74 (95% CI 0.56-0.98, p = 0.037). Other HSCT outcomes did not differ with no improvement ≥2015. LFS, OS, and GRFS were inferior in patients with t (8:21) with HR = 1.32 (95% CI 1.03-1.68, p = 0.026), HR = 1.38 (95% CI 1.04-1.83, p = 0.027) and HR = 01.25 (95% CI 1.02-1.53, p = 0.035), respectively. In conclusion, this retrospective analysis of HSCT in patients with favorable risk AML, transplanted over 16 years showed an increased number of transplants in patients ≥60 years, from Haplo donors with PTCy. Most importantly, 3-year GRFS improved ≥2010 and total chronic GVHD reduced ≥2015, with no significant change in other HSCT outcomes.© 2024. The Author(s), under exclusive licence to Springer Nature Limited.