| BackgroundAllogeneic hematopoietic stem cell transplantation(allo-HSCT)is an important and potentially curative option in most hematologic malignancies and has the potential for lasting remission as a form of immunotherapy.Allo-HSCT treatment risks include graft-versus host disease(GVHD),opportunistic infection,organ damage,bleeding,and so on.Over the past 30 years,funding for clinical and laboratory-based transplant researches has focused more on prevention and treatment of GVHD than on addressing relapse.However,relapse is still one of the main causes of allo-HSCT treatment failure and death.Extramedullary relapse is later than that of bone marrow relapse,and the most common sites are skin and soft tissue.Isolated extramedullary relapse is rare,and it usually indicates systemic recurrence The outcomes of patients with allo-HSCT recurrence were not optimistic,especially for patients with leukemia.Among 351 patients with allo-HSCT recurrence studied by an institution,the 3-year overall survival rate after recurrence was only 19%.Risk factors for mortality after relapse included short-term relapse,high HCT disease risk index,myelin preconditioning,high pretransplant comorbidity index,and GVHD.It is expected to understand the relapse models of different disease types through the analysis of high-risk factors and survival analysis of allo-HSCT recurrence in leukemia patients,and further prevent and treat the relapse of allo-HSCT in leukemia patients before and after transplantation,so as to improve the efficacy of allo-HSCT.PurposeObjective: to investigate the clinical characteristics,risk factors and prognosis of recurrence of leukemia after allogeneic hematopoietic stem cell transplantation.MethodsRespective analysis on January 1,2010 to December 31,2018 in the first affiliated hospital of Zhengzhou university allo-HSCT in patients with acute leukemia,including acute myeloid leukemia(AML)and acute lymphoblastic leukemia(ALL)and its clinical data statistics,analysis of relapse in patients with clinical characteristics and related risk factors of recurrence,and survival analysis for patients.Result1.AML: Univariate analysis showed that high white blood cell syndrome,induction of remission course >1,disease state at the time of transplantation(CR2,no remission),and CMV infection were risk factors for recurrence after transplantation.Multivariate analysis showed that high white blood cell syndrome was an important risk factor for recurrence after transplantation in patients with AML.2.ALL: Intramedullary invasion with onset,induction of remission >1,no acute GVHD,no chronic GVHD was a risk factor for post-transplant ALL recurrence(P<0.05).Multivariate analysis showed that extramedullary invasion and acute GVHD were statistically associated with outcome,with an increased risk of recurrence of extramedullary aggressors,with a risk OR of 2.831(1.199-6.686),and an increased risk of recurrence in acute GVHD with an OR of 0.318.(0.111-0.909).3.Univariate analysis of patients with AML recurrence showed no correlation with ERM.In patients with relapse of ALL,univariate analysis was associated with EMD(P=0.001)and type of transplantation(P=0.033)in association with EMR.The pre-with EMD was an important risk factor for EMR in ALL patients(P=0.009),and the risk coefficient OR was 15.167(2.131~207.579).4.ALL: By the end of follow-up,37 patients had recurrence,and the median disease-free survival time(DFS)was 6 months(1 to 23 months);the average survival time of relapsed patients and non-relapsed patients(OS)were(15.6±11.6)months,(43.6±4.8)months,P=0.041,there were significant differences in OS between the two groups.The median survival time after recurrence in patients without EMR and EMR was(15.0±1.8).The months,(12.0±5.9)months,P=0.447,there was no statistically significant difference between the two groups after recurrence;the mean survival time after recurrence in the isolated EMR group and the non-isolated EMR group were(19.5±2.5)months,respectively.(15.6±2.1)months,P=0.667,there was no statistically significant difference in survival after recurrence;the mean DFS of EMD before transplantation and EMD before transplantation were(6.1±1.1)months,(39.2±4.4).Month,P = 0.001,there was a statistically significant difference between the two groups of DFS.AML: At the end of follow-up,31 patients relapsed,with median DFS in November(February to May);mean OS in relapsed and non-recurrent patients were(31.4 ± 5.8)months,(57.0 ± 4.9)months,respectively.=0.016,there was significant statistical difference between the two groups of OS;the median survival time after recurrence in patients without EMR and EMR was(27.9±6.5)months,(25.4±5.2)months,P=0.706,two groups.There was no statistically significant difference in survival after recurrence.The median survival time after recurrence in patients with isolated EMR and non-isolated EMR was(15.0±1.9)months,(24.9±17.9)months,P=0.739,recurrence in both groups.There was no statistical significance after the survival;the mean DFS of the high white group before transplantation and the high white group before transplantation were(58.7±4.9)months,(25.0±5.2)months,P=0.000,and the DFS of the two groups were statistically significant.difference.Conclusion 1.Patients with AML have an increased risk of replase after transplantation with hyperleukocyte syndrome.2.Patients with ALL had an increased risk of replase after transplantation with extramedullary disease,and the risk of recurrence of aGVHD was reduced after transplantation.3.Patients with ALL had an increased risk of extramedullary relapse after transplantation with extramedullary disease.4.Allogeneic hematopoietic stem cell transplantation in patients with acute leukemia have a poor survival after recurrence,and the recurrence pattern has no effect on the survival of patients with relapse. |
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