对于Ph + ALL的移植后TKIs:迄今为止的实践和临床意义
Satoshi Nishiwaki1, Seitaro Terakura2, Takanobu Morishita3,4
1Department of Advanced Medicine, Nagoya University Hospital, 65 Tsurumai-cho Showa-ku, Nagoya, 4668560, Japan. n-3104@tf7.so-net.ne.jp.
International journal of hematology
|January 17, 2025
概括
移植后的氨酸激酶抑制剂 (TKIs) 在预防费城染色体阳性急性淋巴细胞白血病 (Ph+ALL) 的全源造血细胞移植 (allo-HCT) 后复发方面表现有希望. 现实世界的数据表明,定制的TKI策略可能会改善结果,特别是在选择的低风险患者中.
科学领域:
- 血液学 血液学 血液学
- 在瘤学瘤学.
- 药理学 药理学 是一个学科.
背景情况:
- 同源性造血细胞移植 (allo-HCT) 是费城染色体阳性急性淋巴细胞白血病 (Ph+ALL) 的治愈选择.
- 移植后氨酸激酶抑制剂 (TKIs) 正在探索预防复发,但现实世界的疗效数据有限.
研究的目的:
- 评估移植后TKIs在Ph+ALL患者接受allo-HCT的现实世界的使用和有效性.
- 为了比较预防性TKI使用,可测量的残留疾病 (MRD) 触发的TKI使用和没有TKI使用之间的结果.
主要方法:
- 在七个中心对173名Ph+ALL患者进行了回顾性分析,这些患者在2002年至2022年期间接受了alo-HCT.
- 患者在完全分子缓解 (CMR) 或响应MRD阳性时预防性接受了TKIs.
- 在不同的TKI策略和患者子组之间进行了无复发生存 (RFS) 的比较.
主要成果:
- 移植后28%的患者使用了TKIs (7%的预防,21%的MRD触发).
- 预防性TKIs显示,在非CMR患者中,在alo-HCT (100%对73%) 中,改善5年RFS的趋势.
- 一个特定的低风险亚组 (WBC <15000/μl,没有额外的染色体异常) 无论TKI策略如何,都表现出类似的5年RFS,这表明MRD触发的TKI在这个群体中的有效性.
结论:
- 移植后的TKI在接受alo-HCT.ALL的Ph+ALL患者中很少被使用.
- 预防性TKIs可能有利于某些高风险患者,而MRD触发的TKIs可以在选择的低风险人群中有效.
- 基于个体风险因素的定制TKI策略是有必要的,以优化Ph+ALL的allo-HCT后的结果.
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