Research On Retrospective Multi-center Clinical Study Of T(8;21)Acute Myeloid Leukemia In China

[Objective]t(8;21)acute myeloid leukemia(AML)was classified as a type of leukemia with good prognosis.But long-term survival of t(8;21)AML patients reported in China was 30-50%,much shorter than the survival of 70-80%in other countries.So the goal of study is to analyze the association between the clinical features such as characteristics,laboratory results,treatments and prognosis,to provide study evidence for prognostic stratification of Chinese t(8;21)AML patients.[Methods]A total of 586 t(8;21)AML hospitalized patients in 15 blood disease research centers of northern China from January 2005 to June 2014 was retrospective enrolled in this study.Firstly,the clinical features of 586 patients were summarized about characteristics,laboratory results,treatments,prognosis and outcomes.Secondly,the association between different chemotherapy regimens including cytarabine and prognosis was analyzed,in 255 adult patients who received post-remission consolidation chemotherapy but no hematopoietic stem cell transplantation.Thirdly,the prognostic factors during treatment process were analyzed in 133 adult patients who received hematopoietic stem cell transplantation.[Results]1.The clinical features of 586 t(8;21)AML patients were similar to the report in other countries.In multivariate COX regression analysis,white blood cells,extramedullary infiltration,and C-KIT mutation in the newly diagnosed patients were poor prognostic factors for t(8;21)AML.2.The association between different chemotherapy regimens including cytarabine and prognosis was analyzed in 255 adult t(8;21)AML patients without making HSCT on single cytarabine dose,cytarabine cycles,and acumulated cytarabine dose.High-dose cytarabine(2.0?Ara-c?3.0g/m2)was superior to intermediate-dose cytarabine(1.0<Ara-c<2.0g/m2)in post-remission consolidation chemotherapy for t(8;21)AML.And survival could be greatly improved by single dose of cytarabine(Ara-c>2g/m2),for 3-4 cycles reaching cumulative dose>36g/m2.In addition,WBC>3.5×109/L,PLT<30×109/L,and extramedullary infiltration in the newly diagnosed patients were poor prognostic factors for t(8;21)AML.3.The association between different transplant donor,transplant timing and prognosis was analyzed in 133 adult t(8;21)AML patients with HSCT.Otherwise patients who achieved HSCT after first CR have longer survival than patients after second CR or no remission,P<0.05.There were no significant difference among the patients who achieved auto-HSCT,allo-HSCT,and high-dose cytarabine after first CR on OS and PFS.But the recurrence rate was 42.3%in auto-HSCT group,higher than the other groups.The transplant-related mortality in allo-HSCT group was 15.89%.The patients with AML1-ETO fusion gene quantification(AE)<0.01%before transplant have longer survival time han those patients with AE?0.01%,P<0.05.The patients with C-KIT mutation who accepted HSCT may have longer survival and shorter recurrence.[Conclusion]1.WBC>3.5×109/L,PLT<30×109/L,extramedullary infiltration,and C-KIT mutation in the newly diagnosed patients,were poor prognostic factors for t(8;21)AML.2.During the consolidation chemotherapy after CR1,the patients who achieved single dose of cytarabine ?2g/m2 for 3-4 cycles,or the cumulative dose of cytarabine>36g/m2 had longer survival than others.3.The patients with above-mentioned prognostic factors were recommended to get allo-HSCT after CR1.However auto-HSCT was not recommended for its higher recurrence rate.4.The quantitative level of AML1-ETO fusion gene before HSCT can be used as minimal residual disease to predict recurrence.