Clinical Study On Mixed Transplantationin In The Treatment Of Low-intermediate Risk Acute Leukemia

BackgroundAcute myelogenous leukemia (AML) is a kind of disease which characterized as malignant hematopoietic stem cells cloned. Currently, hematopoietic stem cell transplantation has become one of the most promising effect radical means, and it has already reached an agreement. The traditional hematopoietic stem cell transplantation includes two categories which are autologous hematopoietic stem cell transplantation and allogeneic hematopoietic stem cell transplantation. Autologous hematopoietic stem cell transplantation with high recurrence rate, difficulties of allograft matching and many complications has made some difficulties for clinical treatment. Therefore, we design a mixed transplant program in order to provide a better therapeutic approach for the low risk group of patients with acute myelogenous leukemiaObjectivesTo observe and compare the efficacy, transplantation related complications and long-term prognosis of the mixed hematopoietic stem cell transplantation and autologous hematopoietic stem cell transplantation, in order to searching better therapeutic regimens for the low risk group of patients with acute leukemia.MethodsWe retrospectively analyzed the clinical data of 42 patients with acute myelogenous leukemia with low-intermediate risk who had achieved mixed hematopoietic stem cell transplantation after first completed remission in the first affiliated hospital of xinxiang medical college during October,2003 and January,2011. Among the patients.18 patients were treated with autologous hematopoietic stem cell mixed allogeneic HLA haploidentical bone marrow transplantation (mixed hematopoietic stem cell transplantation group, mixed-HSCT) and 24 patients with Autologous hematopoietic stem cell transplantation. Compare the hematopoietic reconstruction time, agranulocytosis time, the incidence of infection, complications and relapse rate, disease-free survival rate, overall survival rate of 3 years.ResultsAll of the 42 patients received hematopoietic reconstruction. There were no statistical differences in implant time between the two groups including the mixed-HSCT group and autologous hematopoietic stem cell transplantation group (P>0.05), and no significant differences were found in neutropenia and infection rate between the two groups (P>0.05). aGVHD rate was 44.4% in mixed-HSCT group, and the aGVHD grade was both during I to Ⅱ grade, no serious aGVHD and aGVHD associated death occurred, and other transplant-related complications were also not increased significantly (P>0.05). After transplantation,10 cases of patients were detected in mixed-HSCT group, and the formation of mixed chimerism was found in 4 cases of patients.3-years recurrence rate in mixed-HSCT group was significantly lower than auto-HSCT group (P<0.05). And the 3years disease-free survival rate and overall survival rate were significantly higher compared with auto-HSCT group (P<0.05).ConclusionsMixed hematopoietic stem cell transplantation can effectively induce GVL effect, reduce the recurrence rate and increase the overall survival rate, not increase the transplantation related complications. Mixed-HSCT is an effective treatment for acute leukemia with low-intermediate risk.