Unrelated matched versus autologous transplantation in adult patients with good and intermediate risk acute myelogenous leukemia in first molecular remission

作者：Gorin, Norbert-Claude^*; Labopin, Myriam; Pabst, Thomas; Remenyi, Peter; Wu, Depei; Anne Huynh; Volin, Liisa; Cahn, Jean Yves; Yakoub-Agha, Ibrahim; Mercier, Melanie; Houhou, Mohamed; Mohty, Mohamad; Nagler, Arnon

来源：American Journal of Hematology, 2017, 92(12): 1318-1323.

DOI：10.1002/ajh.24904

• STEM-CELL TRANSPLANTATION
• MINIMAL RESIDUAL DISEASE
• ACUTE MYELOID-LEUKEMIA
• MARROW TRANSPLANTATION
• NPM1 MUTATION
• RELAPSE RISK
• AML
• IMPACT
• SURVIVAL
• BLOOD

Patients with Acute Myelogenous Leukemia have a better outcome if reaching molecular remission. We compared the outcome of 373 patients autografted and 335 patients allografted with a 10/10 compatible unrelated donor in first molecular remission. Patients were stratified using the ELN European Leukemia Net classification. ELN favorable group: (234 auto and 70 unrelated transplants). By univariate analysis, in the auto group, the Non Relapse Mortality (NRM) was lower (3.7% versus 19%; P<10(-4)), Relapse Incidence (RI) higher (29% versus 17%, P<10(-4)), Leukemia Free Survival (LFS) identical (67% versus 64%) and Overall Survival (OS) better than in the allogeneic group (83% versus 62%; P=.008). By multivariate analysis, autologous transplantation was associated with a lower NRM (HR: 4, P=.01) and a better OS (HR: 2.08, P=.04). ELN intermediate group 1: (87 autologous and 172 unrelated transplants). By univariate analysis, in the auto group, NRM was lower (2.5% versus 11.8%; P=.03), RI higher (59% versus 18%, P<10(-6)), LFS lower (39% versus 70%; P<10(-6)) and OS lower than in the unrelated donor group (61% versus 74%; P=.005). By multivariate analysis, unrelated donor was superior to autologous transplantation for LFS (HR: 0.36, P<10(-5)) and OS (HR: 0.53, P=.01). ELN intermediate group 2: (52 autologous and 93 unrelated donors). The outcome was identical. We conclude that good risk patients get higher benefit from autologous transplantation. Intermediate risk 2 patients have the same outcome and Intermediate risk 1 patients get higher benefit from unrelated donor transplants.

• 出版日期2017-12
• 单位苏州大学