The Survival Status Of Acute Myeloid Leukemia-from Fujian Union Hospital Single Center Data

Background Acute myeloid leukemia is a malignant tumor of the blood system.Standardized chemotherapy and hematopoietic stem cell transplantation can significantly improve patient survival.However,in the real world,due to patients’ compliance and their own economic reasons,only some patients have regular chemotherapy,and there are still quite a few irregular chemotherapy.Patients in remission after chemotherapy have the option of hematopoietic stem cell transplantation,and most of them do not choose hematopoietic stem cell transplantation.Through retrospective analysis,this study compares the effects of different treatment options on the prognosis of patients,and provides more evidence for clinical individualized treatment.Objective Analyze the impact of three real world treatment options,namely regular chemotherapy,irregular chemotherapy,and transplantation after remission,on the survival outcome of adult AML(AML,non-M3)patients.Methods A collection of 644 newly-treated AML(non-M3 type)patients admitted to the Union Hospital of Fujian Medical University from January 2015 to January 2020.According to different treatment compliance,they were divided into regular chemotherapy group,irregular chemotherapy group,and post-remission hematopoietic stem cell transplantation group.The patients in the three groups were compared with complete remission rate,recurrence rate,progression-free survival(PFS)and overall survival.Time(overall survival,OS)and other indicators.The subgroup analysis was further carried out according to the genetic and molecular prognostic stratification,and the survival of each subgroup was analyzed for the good prognosis,medium prognosis,and poor prognosis group.Results 1.The CR rates of the regular chemotherapy group and the irregular chemotherapy group were 60.77% and 35.87%,respectively.The difference between the two groups was statistically significant(P<0.05);the irregular chemotherapy group and the regular chemotherapy group The recurrence rates of the three groups were48.67%,39.87%,and 4.34%,respectively,and the difference between the three groups was statistically significant.2.The median OS in the regular chemotherapy group was 11(0.5-67)months,and the 5-year OS rate was 29%;the median OS in the transplantation group was 28(8-70)months,and the 5-year OS rate was 74%;irregular chemotherapy The median OS in the group was 9(0.3-70)months,and the 5-year OS rate was 4%.The difference in OS between the three groups was statistically significant.3.Further subgroup analysis showed that the median OS in the regular chemotherapy group was 15.5(0.5-65)months,and the 5-year 0S rate reached 54%;the median OS in the transplantation group was 32.5(10-70)months,5 The annual OS rate was 86%;the median OS in the irregular chemotherapy group was 9.5(0.3-46)months.Prognostic Stratification: The median OS in the regular chemotherapy group was 13(0.5-67)months,and the 5-year OS rate was 26%;the median OS in the transplantation group was 38(10-70)months,and the 5-year OS rate was 78 %;The median OS in the irregular chemotherapy group was 10(0.3-51)months.In the poor prognosis stratification,the median OS in the regular chemotherapy group was 9(0.5-67)months,and the 5-year OS rate was 23%;the median OS in the transplantation group was 26(8-62)months,and the 5-year OS rate was 72 %;The median OS in the irregular chemotherapy group was 9(0.3-70)months,and the 5-year OS rate reached 2%.The differences between the three prognostic stratification groups were statistically significant.4.Grouped according to age,the median OS of the youth(<60 years)group was12(0.3-70)months,and the 5-year OS rate was 27%;the median OS of the elderly(≥60 years)group was 6(0.3-60))Month and 5-year OS rates were 6% respectively;the difference between the two groups was statistically significant.5.The median PFS in the regular chemotherapy group was 10(0.5-67)months,and the 5-year PFS rate was 29%;the median PFS in the transplantation group was 27(8-70)months,and the 5-year PFS rate was 77%;irregular chemotherapy The median PFS in the group was 7.5(0.3-70)months,and the 5-year PFS rate was 6%.The PFS difference between the three groups was statistically significant.Conclusion Analysis of the survival status of adult AML treatment shows that hematopoietic stem cell transplantation has the best long-term survival,followed by regular chemotherapy,and irregular chemotherapy is the worst.Prognostic stratification is based on the premise of regular chemotherapy.Irregular chemotherapy offsets the advantages of prognostic stratification,but transplantation can overcome the disadvantage of poor prognosis.Even if the prognosis is good,transplantation has more advantages.Therefore,hematopoietic stem cell transplantation is the best choice for the treatment of AML,and the treatment of AML should be fully integrated.The long-term survival rate of the elderly is lower than that of the young,and the prognosis is poor.It needs to optimize the individualized chemotherapy treatment plan to improve compliance and efficacy.