Lu Y, Wu T, Zhao Y L, Cao X Y, Liu D Y, Zhang J P, Xiong M, Zhou J R, Sun R J, Wei Z J, Wang H, Liu H X, Wang T, Tong C R, Ji S Q, Lu D P
Bone Marrow Transplantation, Hebei Yanda Lu Daopei Hospital, Langfang 065201, China.
Zhonghua Xue Ye Xue Za Zhi. 2017 Jan 14;38(1):44-49. doi: 10.3760/cma.j.issn.0253-2727.2017.01.010.
To analyze the effect of NCCN (2015) risk stratification on prognosis of patients with acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Retrospective analysis of 258 patients with AML in CR (186 cases in CR(1), 72 cases in CR(2)) who underwent allogeneic HSCT in our hospital between April 2012 and March 2015 according to NCCN (2015) risk stratification. Of them, 63 cases were classified as low risk, 112 cases intermediate risk and 83 cases high risk. ①With the median follow up of 18 (5-41) months, two-year disease free surviva (DFS) in 258 patients was 78.0% (95% 60.4%-96.6%) . Two-year DFS in AML after transplantation was 78.6% (95% 61.0%-96.2%) in low risk, 76.0% (95% 84.0%-93.6%) in intermediate risk and 80.3% (95% 62.7%-97.9%) (=0.886) in high risk groups respectively. ②Univariate analysis showed that DFS has no significant difference in patient age, the median disease course before HSCT, the WBC number at the beginning of the disease, blood routine and chromosomes examination before transplantation, extramedullary disease before transplantation, disease status before transplantation, conditioning regimen, donor type, donor and recipient sex, recipient blood type, transfused MNC number, transfused CD34(+) cell number and transfused CD3(+) cell number. DFS was significant lower in primary AML than that in secondary AML (=0.006) and also lower in MRD positive than that in MRD negative (=0.003) . The accumulative relapse was significant higher in CR(2) compared to that in CR(1) (=0.046) . Accumulative non-relapse mortality (NRM) was significanlyt higher in secondary AML compared to that in primary AML (=0.004) and also higher in MRD positive compared to that in MRD negative (=0.010) . ③Multivariate analysis showed that MRD positive was the only significant factor in DFS and NRM. Allo-HSCT treatment of AML CR patients could achieve a high efficacy, which is similar between CR(1) and CR(2) patients. There is no significant correlation between NCCN (2015) risk stratification and the prognosis of AML patients with allo-HSCT treatment. Pre-conditioning MRD status monitored by multiparameter flow cytometry was the only impact factor on DFS and NRM in allo-HSCT for CR-AML patients.
分析美国国立综合癌症网络（NCCN，2015年版）风险分层对急性髓系白血病（AML）患者异基因造血干细胞移植（allo-HSCT）后预后的影响。回顾性分析2012年4月至2015年3月期间在我院接受allo-HSCT的258例处于完全缓解（CR）期的AML患者（CR(1)期186例，CR(2)期72例），根据NCCN（2015年版）进行风险分层。其中，低危63例，中危112例，高危83例。①中位随访时间为18（5 - 41）个月，258例患者的两年无病生存率（DFS）为78.0%（95%置信区间60.4% - 96.6%）。移植后AML患者的两年DFS在低危组为78.6%（95%置信区间61.0% - 96.2%），中危组为76.0%（95%置信区间84.0% - 93.6%），高危组为80.3%（95%置信区间62.7% - 97.9%）（P = 0.886）。②单因素分析显示，患者年龄、HSCT前疾病病程中位数、疾病初发时白细胞计数、移植前血常规及染色体检查、移植前髓外疾病、移植前疾病状态、预处理方案、供者类型、供者与受者性别、受者血型、输注单个核细胞数量、输注CD34(+)细胞数量及输注CD3(+)细胞数量对DFS均无显著差异。原发性AML患者的DFS显著低于继发性AML患者（P = 0.006），微小残留病（MRD）阳性患者的DFS也低于MRD阴性患者（P = 0.003）。CR(2)期患者的累积复发率显著高于CR(1)期患者（P = 0.046）。继发性AML患者的累积非复发死亡率（NRM）显著高于原发性AML患者（P = 0.004），MRD阳性患者的NRM也高于MRD阴性患者（P = 0.010）。③多因素分析显示，MRD阳性是DFS和NRM的唯一显著因素。AML CR患者的allo-HSCT治疗可获得较高疗效，CR(1)期和CR(2)期患者相似。NCCN（2015年版）风险分层与接受allo-HSCT治疗的AML患者预后无显著相关性。多参数流式细胞术监测的预处理MRD状态是CR-AML患者allo-HSCT中DFS和NRM的唯一影响因素。
