Comparison of Myeloablative (CyTBI, BuCy) versus Reduced-Intensity (FluBu2TBI400) Peripheral Blood Stem Cell Transplantation in Acute Myeloid Leukemia Patients with Pretransplant Low WT1 Expression

Silvia Park , Gi June Min , Sung Soo Park , Seung-Ah Yahng , Young-Woo Jeon , Seung-Hwan Shin , Jae-Ho Yoon , Sung-Eun Lee , Byung Sik Cho , Ki-Seong Eom , Yoo-Jin Kim , Seok Lee , Chang-Ki Min , Seok-Goo Cho , Dong-Wook Kim , Jong Wook Lee , Hee-Je Kim
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引用次数: 9

Abstract

Relapse is a major concern with reduced-intensity conditioning. We analyzed 257 patients with acute myeloid leukemia (AML) who received allogeneic stem cell transplantation (SCT) and fulfilled the following criteria: intermediate- or poor-risk disease by National Comprehensive Cancer Network guidelines (2017, version 3), in first complete remission (CR1) at SCT, received either myeloablative conditioning (MAC; busulfan plus cyclophosphamide or cyclophosphamide plus total body irradiation) or reduced-intensity conditioning (RIC; FluBu2TBI400) peripheral blood SCT from 8/8 matched sibling or unrelated donor, and having bone marrow Wilms tumor gene 1 (WT1) expression results before transplant. We and other groups serially published a predictive value for pretransplant WT1 expression in patients with AML to identify patients at higher risk of relapse. Among the total 257 patients, 191 (74.3%) and 66 (25.7%) patients received MAC and RIC transplants, respectively. WT1 ≥250 copies/104 ABL was defined as WT1high. WT1high before SCT was found to be an independent prognostic factor for inferior overall survival (OS), disease-free survival (DFS), and higher cumulative incidence of relapse (CIR). There were 201 patients with WT1 low expression based upon pretransplant analysis. There was no significant difference in OS, DFS, CIR, and nonrelapse mortality between MAC and RIC patients. To conclude, post-transplant survival or relapse was not different by conditioning intensity in AML CR1 patients whose WT1 level was below 250 copies per 104 ABL at transplantation.

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骨髓清除(CyTBI, BuCy)与降低强度(FluBu2TBI400)外周血干细胞移植在移植前低WT1表达急性髓系白血病患者中的比较
复发是低强度条件反射的主要问题。我们分析了257例接受同种异体干细胞移植(SCT)的急性髓性白血病(AML)患者,他们符合以下标准:国家综合癌症网络指南(2017年,第3版)的中度或低风险疾病,在SCT时首次完全缓解(CR1),接受骨髓清除调节(MAC;磺胺加环磷酰胺或环磷酰胺加全身照射)或降低强度调理(RIC;来自8/8匹配的兄弟姐妹或非亲属供者的外周血SCT,并在移植前有骨髓Wilms肿瘤基因1 (WT1)表达结果。我们和其他研究小组连续发表了移植前WT1表达在AML患者中的预测价值,以识别复发风险较高的患者。在257例患者中,分别有191例(74.3%)和66例(25.7%)患者接受了MAC和RIC移植。WT1≥250拷贝/104 ABL定义为WT1高。发现SCT前wt1高是较差的总生存期(OS)、无病生存期(DFS)和较高的累积复发发生率(CIR)的独立预后因素。移植前分析WT1低表达201例。MAC和RIC患者的OS、DFS、CIR和非复发死亡率无显著差异。综上所述,对于移植时WT1水平低于250拷贝/ 104 ABL的AML CR1患者,移植后生存或复发与调节强度无关。
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来源期刊
CiteScore
6.60
自引率
0.00%
发文量
1061
审稿时长
3-6 weeks
期刊介绍: Biology of Blood and Marrow Transplantation publishes original research reports, reviews, editorials, commentaries, letters to the editor, and hypotheses and is the official publication of the American Society for Transplantation and Cellular Therapy. The journal focuses on current technology and knowledge in the interdisciplinary field of hematopoetic stem cell transplantation.
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