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Title: [Clinical Outcomes and Prognostic Factors of Allogeneic Hematopoietic Stem Cell Transplantation in the Treatment of Refractory/Relapsed Acute Myeloid Leukemia].
Author: Lou D, Liu L, Yan XQ, Gu FN, Zhang YP, Qin WW.
Journal: Zhongguo Shi Yan Xue Ye Xue Za Zhi; 2022 Oct; 30(5):1577-1585. PubMed ID: 36208269.
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. 题目: 异基因造血干细胞移植治疗难治/复发急性髓系白血病的疗效及预后因素分析. 目的: 探讨异基因造血干细胞移植（allo-HSCT）治疗难治/复发急性髓系白血病（AML）患者的疗效及影响预后的相关因素。. 方法: 回顾性分析2013年12月至2020年6月在我院接受allo-HSCT治疗的80例难治/复发AML患者的临床资料，主要观察患者总体生存（OS）率、无病生存（DFS）率、复发率及移植相关死亡（TRM）率，并分析影响移植预后的危险因素。. 结果: 纳入研究的80例患者移植后均获得造血重建，3年OS、DFS率分别为（48.8±6.3）%和（40.8±6.7）%，3年累积复发率为33.8%（95%CI：0.254-0.449），3年累积TRM率为15.0%（95%CI：0.114-0.198）。单因素分析结果显示，移植前未达完全缓解、合并DNMT3A R882突变和移植后合并II-IV度急性移植物抗宿主病（aGVHD）是影响患者OS和DFS的预后不良因素。多因素分析结果显示，合并DNMT3A R882突变和移植后合并II-IV度aGVHD是影响患者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）和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）的独立危险因素。细胞遗传学高危组患者的复发风险为71.4%（95%CI：0.610-0.836），较中危组患者的23.3%（95%CI：0.147-0.370）和低危组患者的23.5%（95%CI：0.127-0.437）明显增加（P=0.006）。. 结论: Allo-HSCT是挽救性治疗难治/复发AML患者的有效手段，合并DNMT3A R882突变和移植后合并II-IV度aGVHD是影响难治/复发AML患者移植预后的独立危险因素。.

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