Èñ±Í¼º ¹éÇ÷º´- °ø°Ý¼º NK ¼¼Æ÷¹éÇ÷º´(Aggressive NK-cell leukemia) µ¿Á¾Á¶Ç÷¸ð¼¼Æ÷À̽Ä(Allogeneic Hematopoietic Cell Transplantation) »ýÁ¸À² È¿°ú
-Allogeneic Hematopoietic Cell Transplantation for Aggressive NK Cell Leukemia-
A Center for International Blood and Marrow Transplant Research Analysis
°ø°ÝÀû NK ¼¼Æ÷ ¹éÇ÷º´ ( Aggressive NK Cell Leukemia, ANKL)Àº ±ØÈ÷ µå¹® ÇüÅÂÀÇ ¹éÇ÷º´À¸·Î ¿¹ÈÄ°¡ ÁÁÁö ¾ÊÀº Èñ±ÍÁúȯÀ¸·Î Æò±Õ »ýÁ¸ ±â°£Àº °Ü¿ì 2 °³¿ùÀÔ´Ï´Ù.
±¹Á¦ Ç÷¾× ¹× °ñ¼ö ÀÌ½Ä ¿¬±¸ ¼¾ÅÍ (CIBMTR)´Â À§½ºÄܽŠÀÇ°ú ´ëÇÐ (MCW)ÀÇ Åë°è ¼¾ÅÍ¿¡ HCT¿¡ ´ëÇÑ ÀÚ¼¼ÇÑ µ¥ÀÌÅ͸¦ Á¦°øÇÏ´Â Àü¼¼°è 500 °³ ÀÌ»óÀÇ ÀÌ½Ä ¼¾ÅÍÀÇ ¿öÅ· ±×·ìÀÔ´Ï´Ù. º» ¿¬±¸´Â ±¹Á¦ Ç÷¾× ¹× °ñ¼ö ÀÌ½Ä ¿¬±¸¼¾ÅÍ µ¥ÀÌÅͺ£À̽ºÀÇ ÀڷḦ ÀÌ¿ëÇÏ¿© ANKL ȯÀÚ¿¡¼ µ¿Á¾ Á¶Ç÷ ¸ð¼¼Æ÷ À̽Ä(Allogeneic Hematopoietic Cell Transplantation, alloHCT) Ä¡·á °á°ú¸¦ ANKL·Î È®Áø µÈ 21 ¸íÀÇ È¯ÀÚ¸¦ ´ë»óÀ¸·Î Æò°¡ÇÏ¿´½À´Ï´Ù.
Ç¥ 1) Baseline characteristics of patients with Aggressive NK-cell Leukemia
±×¸² 1) Post allogeneic transplantation rates of NRM (1a), disease relapse/progression (1a), progression-free survival (PFS) (1b) and overall survival (OS) (1b) in patients with aggressive NK-cell leukemia (ANKL). Post allogeneic transplantation outcomes of ANKL patients in complete remission vs. those with active disease: PFS (1c) and OS (1d). (Source: Biol Blood Marrow Transplant. 2017 May;23(5):853-856. Doi: 10.1016/j.bbmt.2017.01.082)
ȯÀÚ Æ¯¼º : 18¼¼ ÀÌ»óÀÇ ANKL¤° Áø´Ü¹Þ°í alloHCT Ä¡·á¸¦ ¹ÞÀº 2000³âºÎÅÍ 2014³â±îÁö The Center for International Blood and Marrow Transplant Research (CIBMTR) ȯÀÚ¸¦ ´ë»óÀ¸·Î ¿¬±¸ÇÔ. ȯÀÚÀÇ Æò±Õ ¿¬·ÉÀº 42¼¼ ¿´°í ¹éÀÎÀº 15 ¸í (71 %)À̾ú´Ù. 14 ¸íÀÇ È¯ÀÚ (67 %)°¡ alloHCT½Ã ¿ÏÀü °üÇØ (complete remission, CR)¸¦ ¹Þ¾Ò°í 5 ¸íÀÇ È¯ÀÚ°¡ È°µ¿¼º ÁúȯÀ» ¾Î¾Ò´Ù. »ýÁ¸ÀÚÀÇ Áß°£ ÃßÀû °üÂû ±â°£Àº 25 °³¿ù (¹üÀ§ 12-116)À̾ú´Ù.
¿¬±¸°á°ú : SMILE (dexamethasone, methotrexate, ifosfamide, L-asparaginase ¹× etoposide)ÀÌ °¡Àå ÈçÇÑ ÇÁ·ÐÆ®¶óÀÎ Ä¡·á¹ýÀ̾ú°í 17 ¸í (81 %)ÀÌ alloHCT Àü¿¡ ¾Æ½ºÆĶó±â³ªÁ¦ ÇÔÀ¯ ¿ä¹ýÀ» ¹Þ¾Ò´Ù. Áø´Ü°ú alloHCTÀÇ °£°ÝÀº 6 °³¿ùÀ̾ú´Ù (2 ~ 31 °³¿ù ¹üÀ§). 1 Â÷ Ä¡·á ÈÄ 9 ¸í (42 %)ÀÌ µ¿Á¾¿ä¹ýÀ» ¹Þ¾Ò°í, 10 ¸í (48 %)Àº ÀÌ½Ä Àü¿¡ Çϳª ÀÌ»óÀÇ Ä¡·á¸¦ ¹Þ¾Ò´Ù. alloHCT½Ã CR ȯÀÚ´Â 14 ¸í (67 %)À̾ú°í, È°µ¿¼º ÁúȯÀÌÀִ ȯÀÚ´Â 5 ¸íÀ̾ú´Ù. ´ë´Ù¼öÀÇ È¯ÀÚ´Â °ñ¼ö ÀýÁ¦ Á¶Àý ¿ä¹ýÀ» ¹Þ¾Ò´Ù (n = 14).
2³âÀÇ ºñ Àç¹ß »ç¸Á·ü, Àç¹ß / ÁøÇà, ¹« ÁøÇà (PFS) ¹× Àüü »ýÁ¸ (OS)ÀÇ ÃßÁ¤Ä¡´Â °¢°¢ 21 %, 59 %, 20 % ¹× 24 % ·Î ³ªÅ¸³µ´Ù. alloHCT½Ã CR ȯÀÚÀÇ 2 ³â PFS´Â À̽Ľà Ȱµ¿¼º Áúȯ ȯÀÚº¸´Ù À¯ÀÇÇÏ°Ô ¿ì¼öÇß´Ù (30 % ´ë 0 %, P = .001). ºñ½ÁÇÑ ¼ø¼ÀÇ 2 ³â OS´Â 38 % ´ë 0 % (P <.001)¿´´Ù.
°á·ÐÀûÀ¸·Î, ´ëºÎºÐÀÇ ºñ ¾Æ½Ã¾Æ°è ȯÀÚ¸¦ Æ÷ÇÔÇÏ´Â ÀÌ ·¹Áö½ºÆ®¸® ºÐ¼®Àº alloHCT°¡ ANKL ȯÀÚÀÇ °ßµô¸¸ÇÑ Áúº´Á¶ÀýÀ» Á¦°øÇÒ ¼ö ÀÖ´Â °ÍÀ¸·Î ³ªÅ¸³»¾ú´Ù. ÀÌ½Ä Àü CRÀ» ´Þ¼ºÇÏ´Â °ÍÀÌ ¼º°øÀûÀÎ À̽İá°ú¸¦ ¾ò´Â ÀüÁ¦ Á¶°Ç ÀÎ °ÍÀ¸·Î º¸°íµÇ¾ú´Ù.
Reference:
Allogeneic Hematopoietic Cell Transplantation for Aggressive NK Cell Leukemia. A Center for International Blood and Marrow Transplant Research Analysis. Biol Blood Marrow Transplant. 2017 May;23(5):853-856. doi: 10.1016/j.bbmt.2017.01.082.
Allogeneic transplantation provides durable remission in a subset of DLBCL patients relapsing after autologous transplantation. Br J Haematol. 2016 Jul;174(2):235-48. doi: 10.1111/bjh.14046.