Outcome of allogeneic hematopoietic stem cell transplantation for relapsed/refractory acute myeloid leukemia in NR status
10.3760/cma.j.issn.0254-1785.2018.04.006
- VernacularTitle:挽救性异基因造血干细胞移植治疗难治/复发急性髓系白血病疗效分析
- Author:
Lining ZHANG
1
;
Sudong ZHANG
;
Donglin YANG
;
Rongli ZHANG
;
Yi HE
;
Weihua ZHAI
;
Aiming PANG
;
Yong HUANG
;
Jialin WEI
;
Erlie JIANG
;
Zhao WANG
;
Li LIU
;
Yuanqi ZHAO
;
Sizhou FENG
;
Mingzhe HAN
Author Information
1. 中国医学科学院 北京协和医学院 血液学研究所 血液病医院造血干细胞移植中心
- Keywords:
refractory;
relapse;
acute myeloid leukemia;
non-remission status;
allogeneic hematopoietic stem cell transplantation
- From:
Chinese Journal of Organ Transplantation
2018;39(4):217-222
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for relapsed/refractory acute myeloid leukemia (AML) patients in nonremission (NR) status and its related risk factors.Methods Thirty-nine relapsed/refractory AML patients in NR status who received allo-HSCT between Jan.2006 and Dec.2016 were retrospectively analyzed.Major end points of study included overall survival (OS),disease free survival (DFS),and relapse rate.Results All patients achieved hematopoietic reconstitution.Median time to neutrophil and platelet engraftment was 13 (11 20) and 16 (10-58) days,respectively.Acute graft-versus-host disease (aGVHD) occurred in 25 (64.1％) patients,and 11 (31.4％) patients developed chronic GVHD.During a median follow-up period of 9.1 (1.6-93.8) months,11 (28.9％) cases survived,10(26.3％) survived without leukemia,and 21 (53.8％) relapsed.The estimated 2 year OS and DFS were 30.0％ ± 8.0％ and 26.7％ ± 7.7％,and cumulative incidence of relapse and transplantation related mortality at 2 years was 56.63％ (95％ CI 37.84％-71.71％),19.7％ (95％ CI 8.3％-34.5％),respectively.The multivariate analysis revealed that the number of bone marrow blasts≥25％ or any level of blasts in peripheral blood was significantly associated with worse OS (HR =11.91,P=0.003),DFS (HR =10.75,P =0.002) and higher rate of relapse (70.83％ versus 20.22％,P =0.002).In addition,the development of grade Ⅱ-Ⅳ aGVHD also predicted an inferior OS (HR =3.18,P =0.039).Conclusion Salvage therapy with allo-HSCT can induce long-term survival in part refractory/relapsed AML patients.Decrease in the pre-transplant disease burden is the key to reduce relapse and improve survival.
