Jiang S H, Hou C, Chen N, Chen S F, Qiu H Y, Xu Y, Chen S N, Wu D P
First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Collaborative Innovation Center of Hematology, Institute of Hematopoietic Stem Cell Transplantation, Soochow University, Suzhou 215006, China.
Zhonghua Xue Ye Xue Za Zhi. 2018 Jul 14;39(7):558-562. doi: 10.3760/cma.j.issn.0253-2727.2018.07.006.
To investigate the prognosis of allogeneic hematopoietic stem-cell transplantation (allo-HSCT) for patients with acute myeloid leukemia and MLL rearrangement. From September 2009 to May 2016, the clinical data of 47 patients with MLL-rearranged AML undergoing allo-HSCT in the First Affiliated Hospital of Soochow University were retrospectively analyzed. Among 47 MLL-rearranged AML patients, 24 were male and 23 female. The median age was 30 (15-58) years old. There are 36 (76%) patients were FAB-types M4/M5. Two-year overall survival (OS), disease-free survival (DFS), relapse incidence and transplant-related mortality (TRM) were (64.4±8.4)%, (47.3±9.3)%, 41.0% and 17.9%, respectively. Of them, 45 patients were detected with 11q23 translocations, and 2 patients with normal karyotype were MLL partial tandem duplication. According to different chromosome karyotype, 47 patients were divided into three groups: 16 cases of t (6; 11), 15 cases of t (9; 11) and 16 cases of other types. Overall survival was compared between the three groups, there was no significant difference ((2)=1.509, =0.472). On multivariate analysis, independent risk factor on OS was transplant age >45 years [=4.454(95% 1.314-15.099), =0.016]. The multivariate analysis also confirmed the higher TRM in patients at non-CR state when transplanted [=10.370(95% 1.043-103.110), =0.046]. Positive minimal residual disease (MRD) before transplantation was a negative prognostic factor on DFS [=4.236(95% 1.238-14.495), =0.021] and relapse incidence (RI) [=5.491(95% 1.371-21.995), =0.016]. Transplant age (>45 years), allo-HSCT in non-CR state adn positive MRD before transplantation were negative prognostic factors in allo-HSCT for MLL-rearranged AML patients.
探讨急性髓系白血病伴MLL重排患者异基因造血干细胞移植（allo-HSCT）的预后。回顾性分析2009年9月至2016年5月在苏州大学附属第一医院接受allo-HSCT的47例MLL重排急性髓系白血病患者的临床资料。47例MLL重排急性髓系白血病患者中，男性24例，女性23例。中位年龄为30（15 - 58）岁。36例（76%）患者为FAB分型M4/M5。两年总生存（OS）率、无病生存（DFS）率、复发率和移植相关死亡率（TRM）分别为（64.4±8.4）%、（47.3±9.3）%、41.0%和17.9%。其中45例患者检测到11q23易位，2例核型正常患者为MLL部分串联重复。根据不同染色体核型，47例患者分为三组：t（6；11）16例、t（9；11）15例和其他类型16例。比较三组患者的总生存情况，差异无统计学意义（（2）=1.509，=0.472）。多因素分析显示，OS的独立危险因素为移植年龄>45岁[=4.454（95% 1.314 - 15.099），=0.016]。多因素分析还证实，移植时处于非完全缓解（CR）状态的患者TRM较高[=10.370（95% 1.043 - 103.110），=0.046]。移植前微小残留病（MRD）阳性是DFS[=4.236（95% 1.238 - 14.495），=0.021]和复发率（RI）[=5.491（95% 1.371 - 2i.995），=0.016]的不良预后因素。移植年龄（>45岁）、非CR状态下的allo-HSCT以及移植前MRD阳性是MLL重排急性髓系白血病患者allo-HSCT的不良预后因素。
