Early use of allogeneic hematopoietic stem cell transplantation for infants with MLL gene-rearrangement-positive acute lymphoblastic leukemia

被引：43

作者：

Koh, K. ^{[1
]}

Tomizawa, D. ^{[2
]}

Saito, A. Moriya ^{[3
]}

Watanabe, T. ^{[4
]}

Miyamura, T. ^{[5
]}

Hirayama, M. ^{[6
]}

Takahashi, Y. ^{[7
]}

Ogawa, A. ^{[8
]}

Kato, K. ^{[9
]}

Sugita, K. ^{[10
]}

Sato, T. ^{[11
]}

Deguchi, T.

Hayashi, Y. ^{[12
]}

Takita, J. ^{[13
]}

Takeshita, Y. ^{[14
]}

Tsurusawa, M. ^{[15
]}

Horibe, K. ^{[3
]}

Mizutani, S. ^{[2
]}

Ishii, E. ^{[16
]}

机构：

[1] Saitama Childrens Med Ctr, Dept Hematol Oncol, Saitama, Japan

[2] Tokyo Med & Dent Univ, Dept Pediat, Tokyo 1138519, Japan

[3] Nagoya Med Ctr, Natl Hosp Org, Clin Res Ctr, Nagoya, Aichi, Japan

[4] Aichi Gakuin Univ, Fac Psychol & Phys Sci, Dept Nutr Sci, Nagoya, Aichi, Japan

[5] Osaka Univ, Dept Pediat, Osaka, Japan

[6] Mie Univ, Grad Sch Med, Dept Pediat, Tsu, Mie, Japan

[7] Aomori Prefectural Cent Hosp, Dept Pediat, Aomori, Japan

[8] Niigata Canc Ctr Hosp, Dept Pediat, Niigata, Japan

[9] Japanese Red Cross Nagoya First Hosp, Childrens Med Ctr, Dept Hematol & Oncol, Nagoya, Aichi, Japan

[10] Univ Yamanashi, Dept Pediat, Kofu, Yamanashi, Japan

[11] Chiba Univ Hosp, Dept Control & Treatment Infect Dis, Chiba, Japan

[12] Gunma Childrens Med Ctr, Dept Hematol Oncol, Gunma, Japan

[13] Univ Tokyo, Dept Pediat, Tokyo, Japan

[14] Nara Med Univ, Dept Pediat, Nara, Japan

[15] Ama Municipal Hosp, Dept Pediat, Ama, Aichi, Japan

[16] Ehime Univ, Grad Sch Med, Dept Pediat, Matsuyama, Ehime 790, Japan

来源：

LEUKEMIA | 2015年 / 29卷 / 02期

关键词：

CHILDREN; THERAPY; RISK; BUSULFAN;

D O I：

10.1038/leu.2014.172

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Sixty-two infants with MLL gene-rearrangement-positive acute lymphoblastic leukemia (MLL-r ALL) were treated with the MLL03 protocol of the Japanese Pediatric Leukemia/Lymphoma Study Group: short-course intensive chemotherapy followed by early allogeneic hematopoietic stem cell transplantation (HSCT) within 4 months of the initial induction. The 4-year event-free survival and overall survival rates were 43.2% (95% confidence interval (CI) = 30.7-55.1%) and 67.2% (53.8-77.4%), respectively. A univariate analysis showed younger age (<90 days at diagnosis), central nervous system disease and poor response to initial prednisolone therapy significantly associated with poor prognosis (P<0.05). In a multivariate analysis, younger age at diagnosis tended to be associated with poor outcome (hazard ratio = 1.969; 95% CI = 0.903-4.291; P = 0.088). Although the strategy of early use of HSCT effectively prevented early relapse and was feasible for infants with MLL-r ALL, the fact that substantial number of patients still relapsed even though transplanted in their first remission indicates the limited efficacy of allogeneic HSCT for infants with MLL-r ALL. Considering the risk of severe late effects, indications for HSCT should be restricted to specific subgroups with poor risk factors. An alternative approach incorporating molecular-targeted drugs should be established.

引用

页码：290 / 296

页数：7

共 23 条

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