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07 June 2019 : Original article  

Outcome and Prognostic Factors of High-Risk Acute Myeloid Leukemia After Allogeneic Hematopoietic Stem Cell Transplantation

Cheng-ying Zhu12ABCDEF, Guo-feng Chen12C, Wei Zhou1D, Cheng Hou2E, Xiao-kai Wang3C, Fei-yan Wang1C, Nan Yang2F, Li Wang4A, Shu Fang2D, Lan Luo2B, Li-xun Guan2F, Ran Zhang2A, Yu-chen Liu2E, Li-ping Dou2AC, Chun-ji Gao12AG*

DOI: 10.12659/AOT.915381

Ann Transplant 2019; 24:328-340

Abstract

BACKGROUND: Allogeneic transplantation remains one of the best therapies for high-risk acute myeloid leukemia (HR-AML).

MATERIAL AND METHODS: This study retrospectively analyzed 126 patients with HR-AML after allogeneic hematopoietic stem cell transplantation (allo-HCST).

RESULTS: The disease-free survival (DFS) rates of 1 year and 3 years were 58.83% (95%CI: 50.75–68.20%) and 53.09% (95%CI: 44.59–63.22%) respectively. The cumulative relapse rates of 1 year and 3 years were 21.1% (95%CI: 14.4–28.8%) and 25.9% (95%CI: 18.1–34.5%) respectively. The cumulative incidences of III to IV acute graft-versus-host disease (aGVHD) for 100 days was 8.70% (95%CI: 4.6–14.5%). The cumulative rate of extensive chronic graft-versus-host disease (cGVHD) for 1-year was 4.1% (95%CI: 1.5–8.7%). The cumulative transplantation related mortality rate of 1 year and 3 years were 20.1% (95%CI: 13.6–27.6%) and 21.0% (95%CI: 14.3–28.6%) respectively. Univariate analysis revealed that lower overall survival was correlated with age, bacterial or fungal infection, disease status at transplantation, III–IV aGVHD, post-transplantation lymphoproliferative disorders (PTLD), white blood cell engraftment, and extramedullary involvement (P<0.05). The results of multivariate analysis were that the aforementioned factors were also related to lower overall survival except for PTLD (P<0.05). The results of univariate and multivariate analysis were that extramedullary involvement, III–IV aGVHD, and status pre-transplantation influenced DFS (P<0.05). The risk factors for relapse were status pre-transplantation and extramedullary involvement by univariate and multivariate analysis (P<0.05).

CONCLUSIONS: HR-AML has inferior prognosis. Our study indicated the necessity of achieving remission status prior to hematopoietic stem cell transplantation, and administration of preventive treatments on high-risk patients after hematopoietic stem cell transplantation. In addition, adequate prevention and treatment of complications are needed.

Keywords: Disease-Free Survival, Graft vs Host Disease, Leukemia, Myeloid, Acute, Recurrence, Survival Rate, Transplantation, Homologous, young adult

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358