移植前脑脊液细胞学或多参数流式细胞术阳性可预测急性髓性白血病患者异体移植后的不良预后。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2024-07-05 DOI:10.1111/ctr.15396

Li-Juan Hu, Guo-Mei Fu, Yuan-Yuan Zhang, Ya-Zhe Wang, Ya-Zhen Qin, Yue-Yun Lai, Hong-Xia Shi, Hao Jiang, Xiao-Hui Zhang, Lan-Ping Xu, Yu Wang, Qian Jiang, Xiao-Jun Huang, Ying Jun Chang

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引用次数: 0

摘要

导言：中枢神经系统白血病（CNSL）仍是急性髓性白血病（AML）患者的一种严重并发症，也是接受异基因造血干细胞移植（allo-HSCT）患者的一个不明确的预后因素。目前尚不清楚使用多参数流式细胞术（MFC）等更敏感的工具检测脑脊液（CSF）中的胚泡是否会对预后产生影响：我们回顾性分析了1472例急性髓细胞性白血病患者在移植前脑脊液中细胞学或MFC阳性与否的临床结果。44例患者在确诊后的任何时间通过常规细胞学和MFC检测到CSF异常（CSF+）。根据性别、移植年龄和诊断时的白细胞计数，通过倾向得分匹配（PSM）分析产生了一个由175名CSF正常（CSF-）患者组成的对照组：与 CSF 阴性组相比，常规细胞学阳性组和 MFC+ 组的 8 年非复发死亡率（NRM）相当（4%、4% 和 6%，P = 0.82），复发累积发生率（CIR）较高（14%、31% 和 32%，P = 0.007）、较低的无白血病生存率（LFS）（79%、63% 和 64%，P = 0.024）和总生存率（OS）（83%、63% 和 68%，P = 0.021），常规细胞学阳性组和 MFC+ 组之间无显著差异。此外，多变量分析证实，CSF受累是影响OS和LFS的独立因素：我们的研究结果表明，移植前CSF异常是独立影响AML患者异体移植后OS和LFS的不利因素。

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Cytology or Multiparameter Flow Cytometry Positivity in the Cerebrospinal Fluid Before Transplantation is Predictive of Poor Outcomes After Allotransplantation in Acute Myeloid Leukemia Patients

Introduction

Central nervous system leukemia (CNSL) remains a serious complication in patients with acute myeloid leukemia (AML) and an ambiguous prognostic factor for those receiving allo-geneic hematopoiesis stem cell transplantation (allo-HSCT). It is unknown whether using more sensitive tools, such as multiparameter flow cytometry (MFC), to detect blasts in the cerebrospinal fluid (CSF) would have an impact on outcome.

Methods

We retrospectively analyzed the clinical outcomes of 1472 AML patients with or without cytology or MFC positivity in the CSF before transplantation. Abnormal CSF (CSF+) was detected via conventional cytology and MFC in 44 patients at any time after diagnosis. A control group of 175 CSF-normal (CSF−) patients was generated via propensity score matching (PSM) analyses according to sex, age at transplant, and white blood cell count at diagnosis.

Results

Compared to those in the CSF-negative group, the conventional cytology positive and MFC+ groups had comparable 8-year nonrelapse mortality (NRM) (4%, 4%, and 6%, p = 0.82), higher cumulative incidence of relapse (CIR) (14%, 31%, and 32%, p = 0.007), lower leukemia-free survival (LFS) (79%, 63%, and 64%, p = 0.024), and overall survival (OS) (83%, 63%, and 68%, p = 0.021), with no significant differences between the conventional cytology positive and MFC+ groups. Furthermore, multivariate analysis confirmed that CSF involvement was an independent factor affecting OS and LFS.

Conclusion

Our results indicate that pretransplant CSF abnormalities are adverse factors independently affecting OS and LFS after allotransplantation in AML patients.

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.