IntroductionFor the majority of patients with acute myeloid leukemia (AML) an allogeneic stem cell transplant (SCT) in first complete remission (CR) is preferred. However, whether the number of courses required to achieve CR has a prognostic impact is unclear. It is unknown which factors remain important in patients requiring more than one course of induction to attain remission.MethodsThis Acute Leukaemia Working Party study from the European Society for Blood and Marrow Transplantation identified adults who received an allograft in first CR from either a fully matched sibling or 10/10 or 9/10 human leucocyte antigen (HLA)‐matched unrelated donor (HLA‐A, HLA‐B, HLA‐C, HLA‐DR, or HLA‐DQ). Univariate and multivariate analyses were undertaken to identify the prognostic impact of one or two courses of induction to attain CR.ResultsA total of 4995 patients were included with 3839 (77%) patients attaining a CR following one course of induction chemotherapy (IND1), and 1116 patients requiring two courses (IND2) to attain CR. IND2 as compared to IND1 was a poor prognostic factor in a univariate analysis and remained so in a multivariate Cox model, resulting in an increased hazard ratio of relapse (1.38; 95% confidence interval [CI], 1.16–1.64; p = .0003) and of death (1.27; 95% CI, 1.09–1.47; p = .002). Adverse prognostic factors in a multivariate analysis of the outcomes of patients requiring IND2 included age, FLT3‐ITD, adverse cytogenetics, and performance status. Pretransplant measurable residual disease retained a prognostic impact regardless of IND1 or IND2.ConclusionInitial response to chemotherapy as determined by number of courses to attain CR, retained prognostic relevance even following SCT in CR.

中文翻译：

---

接受匹配的兄弟姐妹或人类白细胞抗原 10/10 或 9/10 无关捐赠者移植的急性髓系白血病患者获得完全缓解的诱导疗程次数对预后的影响：欧洲血液和骨髓移植协会急性白血病工作组研究

简介对于大多数急性髓系白血病 (AML) 患者来说，首次完全缓解 (CR) 时首选同种异体干细胞移植 (SCT)。然而，实现 CR 所需的课程数量是否对预后有影响尚不清楚。目前尚不清楚哪些因素对于需要一个以上诱导疗程才能获得缓解的患者仍然很重要。方法欧洲血液和骨髓移植学会的这项急性白血病工作组研究确定了在第一次 CR 中接受来自完全匹配的兄弟姐妹的同种异体移植的成年人或 10/10 或 9/10 人类白细胞抗原 (HLA) 匹配的无关供体（HLA-A、HLA-B、HLA-C、HLA-DR 或 HLA-DQ）。采用单变量和多变量分析来确定一或两个疗程诱导化疗对达到 CR 的预后影响。 结果 总共纳入 4995 名患者，其中 3839 名 (77%) 患者在一个疗程诱导化疗 (IND1) 后获得 CR，并且1116 名患者需要两个疗程 (IND2) 才能达到 CR。与 IND1 相比，IND2 在单变量分析中是一个较差的预后因素，在多变量 Cox 模型中仍然如此，导致复发风险比增加（1.38；95% 置信区间 [CI]，1.16-1.64；p= .0003）和死亡（1.27；95% CI，1.09–1.47；p= .002)。对需要 IND2 的患者结果进行的多变量分析中的不良预后因素包括年龄、FLT3‐ITD、不良细胞遗传学和体能状态。无论 IND1 或 IND2，移植前可测量的残留病灶都保留了预后影响。结论：化疗的初始反应由达到 CR 的疗程数决定，即使在 CR 的 SCT 后也保留了预后相关性。