慢性移植物抗宿主病对急性髓系白血病患者复发及生存的影响

OBJECTIVE: To explore the influence of relapse and survival by chronic graft versus host disease (cGVHD) in patients with acute myeloid leukemia (AML) after allogeneic hematopoietics stem cell transplantation (allo-HSCT). METHODS: Fifty-five AML patients received allo-HSCT were retrospectively reviewed. Relapse rate and overall survival (OS) were analyzed according to cGVHD. RESULTS: cGVHD significantly decreased the relapse rate of AML patients after transplantation within 2 years when compared with those without cGVHD (8.7% vs 38.6%,P=0.019), however, cGVHD had no effect on the long-term relapse rate (22.8% vs 5.9%,P=0.217). cGVHD had no effect on OS within 2 years(78.3% vs 61.0%,P=0.155) but could decrease the rate of long-term survival (63.7% vs 100%, P=0.01). cGVHD also could reduce the rate of relapse (8.3% vs 46.2%,P=0.044) and enhanced the rate of survival (83.3% vs 47.2%,P=0.045) in patients with high risk AML after allo-HSCT in 2 years, while it had no effect on the relapse rate and OS in patients with low and intermediated risk AML in early and late phase. Moreover, compared with the rate of relapse (38.6%) in patients without cGVHD, the rate of relapse were lower in patients with limited cGVHD and intensive cGVHD (27.3% and 31.3%, respectively) but the long-term survival was significantly lower (53.3%,P=0.001) in those patients with intensive cGVHD after all-HSCT. CONCLUSION: The benefit effect of cGVHD mainly took place within 2 years after allo-HSCT in AML patients especially in those with high risk, while in late phase after allo-HSCT, cGVHD especially intensive cGVHD had an effect on reducing long-term survival.