Comparison of autologous, matched sibling, and alternative donor stem cell transplant outcomes for acute myeloid leukemia patients in first remission: A propensity score matching study

IF 3.3 4区医学 Q2 HEMATOLOGY

Hematological Oncology Pub Date : 2023-09-26 DOI:10.1002/hon.3230

Mingyang Wang, Haixiao Zhang, Xinhui Zheng, Jia Liu, Jiali Wang, Yigeng Cao, Xiaoyu Zhang, Rongli Zhang, Xin Chen, Weihua Zhai, Qiaoling Ma, Jialin Wei, Yong Huang, Donglin Yang, Yi He, Aiming Pang, Sizhou Feng, Mingzhe Han, Erlie Jiang

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引用次数: 0

Abstract

Autologous hematopoietic stem cell transplantation (auto-HSCT), matched sibling donor HSCT (MSD-HSCT), and alternative donor HSCT (AD-HSCT) are viable post-remission treatment options for acute myeloid leukemia (AML). A total of 283 de novo favorable- and intermediate-risk AML patients, based on the ELN 2022 criteria, in first complete remission were initially included for propensity score matching. Following the matching process, 126 patients were selected for further analysis, with 42 patients in each of the auto-HSCT, MSD-HSCT, and AD-HSCT groups. Among the AD-HSCT group, 38 of 42 (90.5%) patients received haploidentical HSCT. In patients with persistent undetectable measurable residual disease (uMRD) before transplant (n = 83), overall survival (OS) was similar across the groups. However, auto-HSCT showed a trend of increased disease-free survival (DFS) compared to AD-HSCT (HR 2.85, P = 0.09), resulting in a 3-year DFS and OS of 79.1% and 82.8%, respectively. In the non-persistent uMRD group (n = 38), auto-HSCT exhibited a tendency to increase the risk of relapse, particularly when compared to AD-HSCT (HR 0.24, P = 0.07), but this did not result in inferior OS. The monthly direct medical cost per patient within the first 2 years after HSCT was significantly lower in auto-HSCT compared to MSD-HSCT (P = 0.015) and AD-HSCT (P < 0.001). Our results provide evidence for the use of auto-HSCT as a viable therapeutic option for favorable- and intermediate-risk de novo AML patients in first complete remission with persistent uMRD. Additionally, our findings demonstrated a notable cost advantage associated with auto-HSCT compared to MSD-HSCT and AD-HSCT.

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急性髓系白血病患者首次缓解期自体、配对兄弟姐妹和替代供体干细胞移植结果的比较：一项倾向评分匹配研究。

自体造血干细胞移植（auto-HSCT）、配对兄弟供体HSCT（MSD-HSCT。根据ELN 2022标准，共有283名首次完全缓解的新发良危和中危AML患者最初被纳入倾向评分匹配。在匹配过程之后，选择126名患者进行进一步分析，其中42名患者分别属于自体HSCT、MSD-HSCT和AD-HSCT组。在AD-HSCT组中，42例患者中有38例（90.5%）接受了单倍体HSCT。在移植前持续存在无法检测的可测量残余疾病（uMRD）的患者中（n=83），各组的总生存率（OS）相似。然而，与AD-HSCT相比，自体HSCT显示出无病生存期（DFS）增加的趋势（HR 2.85，P=0.09），导致3年DFS和OS分别为79.1%和82.8%。在非持续性uMRD组（n=38）中，自体HSCT表现出增加复发风险的趋势，特别是与AD-HSCT相比（HR 0.24，P=0.07），但这并没有导致较差的OS。与MSD-HSCT（P=0.015）和AD-HSCT相比，自体HSCT在HSCT后前2年内每位患者的每月直接医疗费用显著降低（P

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来源期刊

Hematological Oncology 医学-血液学

CiteScore

4.20

自引率

6.10%

发文量

147

审稿时长

>12 weeks

期刊介绍： Hematological Oncology considers for publication articles dealing with experimental and clinical aspects of neoplastic diseases of the hemopoietic and lymphoid systems and relevant related matters. Translational studies applying basic science to clinical issues are particularly welcomed. Manuscripts dealing with the following areas are encouraged: -Clinical practice and management of hematological neoplasia, including: acute and chronic leukemias, malignant lymphomas, myeloproliferative disorders -Diagnostic investigations, including imaging and laboratory assays -Epidemiology, pathology and pathobiology of hematological neoplasia of hematological diseases -Therapeutic issues including Phase 1, 2 or 3 trials as well as allogeneic and autologous stem cell transplantation studies -Aspects of the cell biology, molecular biology, molecular genetics and cytogenetics of normal or diseased hematopoeisis and lymphopoiesis, including stem cells and cytokines and other regulatory systems. Concise, topical review material is welcomed, especially if it makes new concepts and ideas accessible to a wider community. Proposals for review material may be discussed with the Editor-in-Chief. Collections of case material and case reports will be considered only if they have broader scientific or clinical relevance.