Clinical Outcomes and Prognostic Factors of Allogeneic Hematopoietic Stem Cell Transplantation in the Treatment of Refractory/Relapsed Acute Myeloid Leukemia.
10.19746/j.cnki.issn.1009-2137.2022.05.043
- Author:
Dian LOU
1
;
Li LIU
1
;
Xue-Qian YAN
1
;
Fang-Na GU
1
;
Yang-Ping ZHANG
1
;
Wei-Wei QIN
2
Author Information
1. Department of Hematology, The Second Affiliated Hospital of Air Force Medical University, Xi'an 710038, Shaanxi Province, China.
2. Department of Hematology, The Second Affiliated Hospital of Air Force Medical University, Xi'an 710038, Shaanxi Province, China.E-mail: vivianq1126@126.com.
- Publication Type:Journal Article
- Keywords:
refractory;
acute myeloid leukemia;
hematopoietic stem cell transplantation;
prognosis;
relapsed
- MeSH:
Graft vs Host Disease;
Hematopoietic Stem Cell Transplantation/adverse effects*;
Humans;
Leukemia, Myeloid, Acute/therapy*;
Prognosis;
Recurrence;
Retrospective Studies;
Transplantation, Homologous/adverse effects*
- From:
Journal of Experimental Hematology
2022;30(5):1577-1585
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE:To investigate the clinical outcomes and prognostic factors of refractory/relapsed acute myeloid leukemia (AML) patients who received allogeneic hematopoietic stem cell transplantation (allo-HSCT).
METHODS:The clinical data of 80 refractory/relapsed AML patients who received allo-HSCT from December 2013 to June 2020 were retrospectively analyzed, including the overall survival (OS) rate, disease-free survival (DFS) rate, relapse rate, incidence of transplant-related mortality (TRM), and the related risk factors were explored.
RESULTS:Hematopoietic reconstitution was obtained in all 80 patients after transplantation, the 3-year OS and DFS rates were (48.8±6.3)% and (40.8±6.7)%, respectively. The 3-year cumulative incidence of relapse and TRM were 33.8% (95%CI: 0.254-0.449) and 15.0%(95%CI: 0.114-0.198), respectively. Univariate analysis showed that non-remission (NR) status before transplantation, DNMT3A R882 mutations and grade II-IV acute graft-versus-host disease (aGVHD) had negative effects on OS and DFS. Multivariate analysis indicated that the DNMT3A R882 mutations and grade II-IV aGVHD were independent risk factors for OS (HR=0.253, 95%CI: 0.092-0.695, P=0.008; HR=5.681, 95%CI: 2.101-15.361, P=0.001) and DFS (HR=0.200, 95%CI: 0.071-0.569, P=0.003; HR=7.117, 95%CI: 2.556-19.818, P<0.001). The 3-year cumulative incidence of relapse was 71.4%(95%CI: 0.610-0.836) in genetic high-risk group, which was higher than 23.3%(95%CI: 0.147-0.370) in intermediate-risk group and 23.5%(95%CI: 0.127-0.437) in favorable-risk group (P=0.006).
CONCLUSION:Allo-HSCT is an effective and safe choice for refractory/relapsed AML patients. DNMT3A R882 mutations and grade II-IV aGVHD are negative prognostic factors of allo-HSCT for refractory/relapsed AML patients.
