背景:异基因干细胞移植(allo-SCT)后疾病复发是治疗急性髓系白血病(AML)和骨髓增生异常综合征(MDS)的主要挑战。我们根据不同的治疗方法调查了allo-SCT复发后的总体生存率(OS)。
方法:我们分析了2015年至2021年在圣安托万大学医院进行allo-SCT后复发的134例患者,ParisandSpedaliCivilidiBrescia,布雷西亚.其中,103(77%)接受治疗,包括69/103(67%)在明显复发时接受治疗,34/103(33%)在分子/细胞遗传学复发或混合嵌合发生时以先发制人的方式接受治疗。40/103(39%)患者的治疗是基于供体淋巴细胞输注(DLI)。
结果:1-,2-,接受DLI治疗的患者(n=40)的5年OS为67%,34%,34%,分别,对于预防性治疗的人(n=20)和43%,20%,20%,分别,对于明显复发的患者(n=20)(p<0.01)。1-,2-,未接受DLI治疗的患者(n=63)的5年OS为54%,40%,26%,分别,对于那些预防性治疗的人(n=14)和17%,5%,0%,分别,对于明显复发的患者(n=49)(p<0.01)。
结论:采用先发制人策略的复发治疗与改善预后相关,特别是在使用DLI时。
BACKGROUND: Disease relapse after allogeneic stem cell transplantation (allo-SCT) is the main challenge for curing acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). We investigated the overall survival (OS) after allo-SCT relapse according to different therapeutic approaches.
METHODS: We analyzed 134 patients who relapsed after allo-SCT performed between 2015 and 2021 at Saint-Antoine University Hospital, Paris and Spedali Civili di Brescia, Brescia. Of these, 103 (77%) were treated, comprising 69/103 (67%) who received therapy in overt relapse and 34/103 (33%) who were treated in a pre-emptive manner when molecular/cytogenetics recurrence or mixed chimerism occurred. The treatment was donor lymphocyte infusion (DLI)-based for 40/103 (39%) patients.
RESULTS: The 1-, 2-, and 5-year OS of patients treated with DLI (n = 40) was 67%, 34%, and 34%, respectively, for those treated preventively (n = 20) and 43%, 20%, and 20%, respectively, for those treated in overt relapse (n = 20) (p < 0.01). The 1-, 2-, and 5-year OS of patients treated without DLI (n = 63) was 54%, 40%, and 26%, respectively, for those treated preventively (n = 14) and 17%, 5%, and 0%, respectively, for those treated in overt relapse (n = 49) (p < 0.01).
CONCLUSIONS: Relapse treatment with a pre-emptive strategy was associated with improved outcomes, particularly when DLI was employed.