移植前病程对急性髓系白血病患者异基因造血干细胞移植预后的影响

OBJECTIVE: To evaluate the impact of pre-transplant course on transplant outcomes in patients with acute myeloid leukemia (AML). METHODS: A retrospective analysis was conducted in 107 patients with AML who received allogeneic hematopoietic stem cells transplantation (allo-HSCT) in the first complete remission stage (CR(1)) from January 2012 to June 2014. RESULTS: ①46 cases received allo-HSCT within 6 months upon diagnosis, including 25 males and 21 females, with a median age of 26 (12–60) y. 61 cases received allo-HSCT after 6 months upon diagnosis, including 34 males and 27 females, with a median age of 31 (14–58) years. There is no statistical significance in patients' age, gender, NCCN risk stratification, courses for induction, minimal residual disease (MRD) status, transplantation type and infection rates prior to transplantation. Total courses of chemotherapy before allo-HSCT were 4 (3–5) and 5 (4–10) for the two groups, respectively. ②Incidences of Grade Ⅱ–Ⅳ aGVHD were 26.09% (12/46) for the <6-month group and 24.59% (15/61) for the ≥6 months group (P=0.860). Incidences of Grade Ⅲ/Ⅳ aGVHD were 2.17% (1/46) for the <6-month group and 14.75% (9/61) for the ≥6 months group (P=0.027). ③Probabilities of 2-year overall survival (OS) were (90.3±4.6) % for the <6 months group and (75.7±5.7) % for the ≥6 months group (P=0.042). Probabilities of 2-year disease-free survival (DFS) were (90.7±4.4) % for the <6 months group and (76.3±5.5) % for the ≥6 months group (P=0.038). ④During the median follow-up of 863 (26–2 026) days, cumulative incidences of non-relapse mortality were (4.4±3.1) % for the <6 months group and (18.2±5.0) % for the ≥6 months group (P=0.047). ⑤Univariate analysis showed that age, NCCN risk stratification, MRD status before transplantation and rates of infection was not related to transplantation outcomes. Chemotherapy courses before allo-HSCT (≤4 or >4) was related to OS and DFS (P=0.044, P=0.039), but not to NRM (P=0.079). CONCLUSION: AML patients who obtained CR(1) could achieve better long-term survival by receiving allo-HSCT within 6 months after diagnosis.