| Autor: |
Lyu MN; Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China., Jiang EL; Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China., He Y; Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China., Yang DL; Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China., Ma QL; Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China., Pang AM; Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China., Zhai WH; Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China., Wei JL; Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China., Huang Y; Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China., Zhang GX; Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China., Zhang RL; Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China., Feng SZ; Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China., Han MZ; Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China. |
| Abstrakt: |
Objective: To compare the efficacy of autologous HSCT (auto-HSCT) with matched sibling donor (MSD) HSCT in Ph(+) ALL and provide a basis for the choice of transplantation method. Methods: We retrospectively investigated the outcomes of 78 adult patients with Ph(+) ALL who underwent auto-HSCT ( n =31) and MSD-HSCT ( n =47) in Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, from January 2008 to December 2017. The overall survival (OS) rate, leukemia-free survival (LFS) rate, cumulative incidence of relapse (CIR) rate, nonrelapse mortality (NRM) rate, and the impact of achievement of complete molecular response (CMR) within 3 months and sustaining CMR up to transplantation (s3CMR) on transplantation method were explored. Results: The median time of neutrophil and platelet reconstitution in auto-HSCT and MSD-HSCT groups were 12 (10-29) days vs 14 (11-24) days ( P =0.006) and 17.5 (10-62) days vs 7 (10-33) days ( P =0.794) , respectively. In the MSD-HSCT group, the incidence of Ⅱ-Ⅳ and Ⅲ-Ⅳ acute graft-versus-host disease (GVHD) was 27.7% (13/47) and 8.5% (4/47) , respectively. The incidence of limited and extensive chronic GVHD was 17.0% (8/47) and 12.8% (6/47) , respectively. The estimated CIR, NRM, LFS, and OS at 3 years were not significantly different between auto-HSCT and MSD-HSCT groups ( P >0.05) . For 44 patients who achieved s3CMR, 3-year OS[ (84.0±8.6) % vs (78.0±8.7) %, P =0.612], LFS[ (70.3±10.3) % vs (68.2±10.1) %, P =0.970], CIR[ (24.9±10.0) % vs (14.4±8.0) %, P =0.286], and NRM[ (4.7±4.7) % vs (17.4±8.1) %, P =0.209] of the auto-HSCT and MSD-HSCT groups were not significantly different. However, for 34 patients who did not reach s3CMR, 3-year cumulative relapse rate of patients in the auto-HSCT group was significantly higher than MSD-HSCT group[ (80.0±14.7) % vs (39.6±10.9) %, P =0.057]. Conclusions: auto-HSCT with maintenance therapy after HSCT appears to be an attractive treatment option for patients with Ph(+) ALL especially for those with s3CMR maintained up to transplantation. For non-s3CMR patients, allogeneic transplantation may be more effective from lower relapse. |
