Outcome And Prognosis In Acute Myeloid Leukemia Patients Treated With Hematopoietic Stem Cell Transplantation

Currently, allogeneic hematopoietic stem cell transplantation is the hope of curingpatients with acute myeloid leukemia. Part of patients after transplantation can appear earlyrecurrence and treatment-related mortality, which affects the extensive application ofallogeneic hematopoietic stem cell transplantation. To evaluate the outcome of acutemyeloid leukemia patients treated with allogeneic peripheral blood stem celltransplantation (PBSCT) and analyse the potential prognostic factors, a total of108acutemyeloid leukemia hospitalized patients treated with PBSCT inpatiented in The ChinesePLA general hospital from January2008to august2012were retrospectively analyzed. Allpatients received either HLA-matched related (n=56)or mismatched related donor(n=31)or unrelated donor(n=21) mobilized peripheral blood stem cells．All patients were followedup and evaluated for overall survival(OS)，leukemia-free surviva（lLFS），relapse rate（RR）and analyze the potential prognostic factors. The results showed that the3-year estimatesof OS, LFS, RR were （66.2±4.6）%，（63.7±4.7）%and（24.7±4.4）%，respectively．Itwas demonstrated that type of donor（P=0.000）、white blood cell count at initial diagnosis（P=0.006）、status of disease before transplantation（P=0.003）are related with outcomesby univarite analysis. Type of donor（P=0.002），white blood cell count at initial diagnosis（P=0.001），status of disease before transplantation（P=0.011）are the most importantprognostic factors by multivariate analysis. Research results show that, the allogeneicPBSCT is effective treatment for AML patient; recurrence is the main reason for the failureafter transplantation; type of donor，white blood cell count at initial diagnosis，status ofdisease before transplantation are independent prognostic factors.In order to further research different outcomes between allogeneic peripheral bloodhematopoietic stem cell transplantation and other treatment methods, and eliminate theinfluence of different between subtypes of AML, We further analyzed the t (8;21) AML which is a common type in AML. From December2007to October2012，the clinical dataof46patients with AML1/ETO (+) acute myeloid leukemia was retrospectively analyzed,and regular quantitative monitoring of AML1-ETO fusion gene was done. The medianfollow-up time was26(7.8~75.8) months. Kaplan-Meier analysis was used to result inoverall survival, progression-free survival (PFS) and cumulative relapse rate. Log-rankmethod was used to result in univariate analysis, and applies the COX regression model toevaluate the related factors influencing the curative effect. Results show that, the initialclinical symptoms of lots of patients were anemia and infections; the peripheral WBC in58.7%of patients was lower by10×109/L, and karyotype analysis showed that sexchromosome loss was in58%patients. CR rate of treatment for the first course and secondcourse were76.1%and97.8%, respectively. The3-year estimates of OS、PFS、RR were（79.6+6.1）%、（68.5+7.1）%、（28.2+7）%，respectively．Minimal residual diseasemonitoring can predict early recurrence of disease. Age more than35years old caninfluence the OS. Research results show that, AML1/ETO (+) AML patients have goodtreatment effect and regular quantitative monitoring of AML1/ETO expression level canpredict early recurrence; allogeneic hematopoietic stem cell transplantation for high-riskpatients with relapse after chemical therapy or autologous transplantation or with complexkaryotype might achieve another opportunity to obtain long-term survival; age more than35years old is an independent prognostic factors.