The Effect Of Pre-treatment Platelet Count On The Prognosis Of AML Patients With Allogeneic Hematopoietic Stem Cell Transplantation

Backgroud and Objective:Platelet count affects the progression and prognosis of multiple solid tumors,and the relationship between pre-treatment platelet levels and the prognosis of patients with non-M3 acute myeloid leukemia receiving allogeneic hematopoietic stem cell transplantation(allo-HSCT)remains unclear.The purpose of this study was to investigate the effect of pretreatment platelet count on the efficacy and prognosis of chemotherapy and allogeneic hematopoietic stem cell transplantation(allo-HSCT)for acute myeloid leukemia.Methods:The clinical data of 524 patients with non-M3 acute myeloid leukemia receiving allo-hsct in the first affiliated hospital of Soochow University from October 2007 to May 2017 were retrospectively analyzed.According to the pretreatment platelet count,the patients were divided into three groups:A(<20×109/L),B(20-50×109/L)and C(>50×109/L).The efficacy of induction therapy,overall survival rate(OS),disease-free survival rate(DFS),relapse-free survival rate(RFS),Relapse-free mortality rate(NRM)and cumulative recurrence rate(CIR)of each group were compared,and univariate and multivariate analyses were performed.Results:The remission rate after 1 or 2 courses of induction chemotherapy was 89.1%,87.I%and 75%(P=0.001)in the newly diagnosed platelet group A,B and C,respectively,and the difference was statistically significant.The 3-year overall survival rate(OS)was 66.9%,69.2%and 56.3%,respectively(P=0.082).The 3-year disease-free survival rate(DFS)was 62.8%,66%and 53.6%,respectively(P=0.030),and the difference was statistically significant.The 3-year relapse-free survival rates(RFS)were 66.7%,68.2%and 60.7%,respectively(P=0.322).The 3-year recurrence free mortality(NRM)was 16.1%,18.6%and 20.4%,respectively(P=0.771).The 3-year cumulative recurrence rate(CIR)was 18.6%,12.4%and 20.3%,respectively(P=0.200).Univariate analysis showed that the induction remission rate,3-year OS,3-year DFS and 3-year CIR of platelet group C were worse than that of platelet group B(P values were 0.018,0.042,0.039 and 0.008,respectively),and there was no significant difference in 3-year RFS.Compared with group A,the induced response rate of platelet group C was lower than that of group A(P=0.021),and there was no statistical difference in 3-year OS,3-year DFS,3-year CIR and 3-year RFS.There were no statistically significant differences in induced response rate,3-year OS,3-year DFS,3-year RFS,3-year NRM,and 3-year CIR between platelet group B and group A.The results of multivariate analysis showed that:compared with group B,the induced response rate and 3-year DFS of group C were lower than those of group B(P values were 0.040 and 0.039,respectively),and the 3-year CIR of group C was higher than that of group B(P=0.048).There was no statistieal difference in 3-year OS and 3-year RFS.Compared with group C,the remission rate in group A was superior to that in group C(P=0.080).The National Comprehensive Cancer Network(NCCN)risk stratification high-risk group is an independent risk factor affecting the induction efficacy,OS,DFS and CIR.Chronic graft-versus-host disease(cGVHD),1 or 2 course of treatment induced remission rate are good prognostic factors for OS,DFS and NRM.?-? acute graft versus host disease(aGVHD)related to the NRM.Conclusion:The number of newly diagnosed platelets was correlated with the prognosis of patients with non-M3 acute myeloid leukemia who received allo-HSCT for the first time.