Wang Qing-Yun, Dong Yu-Jun, Liang Ze-Yin, Yin Yue, Liu Wei, Xu Wei-Lin, Sun Yu-Hua, Han Na, Li Yuan, Ren Han-Yun
Department of Hematology, Peking University First Hospital, Beijing 100034, China.
Department of Hematology, Peking University First Hospital, Beijing 100034, China,E-mail:
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2020 Aug;28(4):1105-1114. doi: 10.19746/j.cnki.issn.1009-2137.2020.04.005.
To analyze risk factors that affect survival and relapse of AML patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and to investigate the therapy choices after AML relapse.
Clinical data of 180 AML patients achieved complete remission (CR) before HSCT from January 2009 to December 2018 treated in our center were analyzed retrospectively. Risk factors for survival and relapse after allo-HSCT were analyzed by COX regression.
Among 180 AML patients, 134 survived (74.4%), 46 patients died (25.6%), and 40 patients relapsed (22.2%). The rate of overall survival (OS), event-free survival (EFS) and cumulative rate of relapse in 5-years was 74.3%、42.5% and 25.0%, respectively. High-risk, adverse cytogenetics, CR at HSCT and no cGvHD were independent risk factors that affect OS. CR at HSCT, high-risk were independent risk factors that affect EFS. High-risk, MRD after one course of induction therapy, adverse cytogenetics and no cGVHD were independent risk factors that affect relapse. The OS rate of relapse patients could be improved by the usage of hypomethylation agents combined with G-CSF mobilized donor lymphocyte infusion (DLI), and 2-year OS rate was 62.5%.
The survival rate of AML is greatly improved by allo-HSCT, but relapse is still one of the most important factors that influence survival of the AML patients. The maintenance therapy of hypomethylation agents combined with DLI may be a new effective treatment option for patients who relapse after HSCT.
分析影响急性髓系白血病（AML）患者异基因造血干细胞移植（allo-HSCT）后生存及复发的危险因素，并探讨AML复发后的治疗选择。
回顾性分析2009年1月至2018年12月在本中心接受HSCT前达到完全缓解（CR）的180例AML患者的临床资料。采用COX回归分析allo-HSCT后生存及复发的危险因素。
180例AML患者中，134例存活（74.4%），46例死亡（25.6%），40例复发（22.2%）。5年总生存率（OS）、无事件生存率（EFS）和累积复发率分别为74.3%、42.5%和25.0%。高危、不良细胞遗传学、HSCT时CR及无慢性移植物抗宿主病（cGvHD）是影响OS的独立危险因素。HSCT时CR、高危是影响EFS的独立危险因素。高危、诱导治疗1疗程后微小残留病（MRD）、不良细胞遗传学及无cGVHD是影响复发的独立危险因素。复发患者使用去甲基化药物联合粒细胞集落刺激因子（G-CSF）动员的供者淋巴细胞输注（DLI）可提高OS率，2年OS率为62.5%。
allo-HSCT使AML患者生存率大幅提高，但复发仍是影响AML患者生存的最重要因素之一。去甲基化药物联合DLI的维持治疗可能是HSCT后复发患者新的有效治疗选择。
