To explore prognostic factors in intermediate-risk acute myeloid leukemia (AML) patients with minimal residual disease (MRD) negativity (MRD<0.1%,MRD-)receiving autologous hematopoietic stem cell transplantation (auto-HSCT).A total of 59 intermediate-risk AML patients with MRD-were treated with auto-HSCT from January 2015 to September 2021 at Affiliated People's Hospital of Ningbo University. The clinical data and laboratory results were collected retrospectively. Efficacy, clinical outcome and prognostic factors were analyzed. Univariate analysis was conducted by using log-rank test, the multivariate analysis by Cox proportional risk model.Among 59 patients, there were 27 males and 32 females with median age of 55 (31-69) years old.The median follow-up was 761(317-1 861)days. The 2-year overall survival (OS) rate and event-free survival (EFS) rate were 76.1%±11.4% and 73.4%±11.6% respectively.The univariate analysis showed that age older than 50 years, TET2 gene mutation (TET2+), achieving MRD negativity over 30 days (MRD30+) were unfavorable factors of OS (χ2=6.20, 33.20, 7.18;P=0.013,<0.001, 0.007). TET2+, WT1 gene mutation (WT1+), CD34+cells<2×106/kg, MRD30+were negative factors of EFS (χ2=17.29, 4.47, 3.94, 9.393;P<0.001, 0.035, 0.047, 0.002).Multivariate analysis showed that MRD30+, TET2+ were independent prognostic factors of OS and EFS (OS:HR=9.251, 25.839, P=0.036, 0.001;EFS:HR=5.851, 9.199, P=0.043, 0.002). Intermediate-risk AML patients with MRD30+or TET2+ have very poor prognosis after auto-HSCT. Alternative regimens should be investigated.
探讨影响自体造血干细胞移植（auto-HSCT）对于微小残留病阴性（MRD<0.1%，MRD-）中危急性髓系白血病（AML）预后的因素。对2015年1月至2021年9月在宁波大学附属人民医院接受auto-HSCT的59例MRD-中危AML患者进行回顾性分析，收集一般资料、实验室及辅助检查结果等病例基本资料，分析临床疗效、预后及其影响因素。应用Kaplan-Meier法进行生存分析，log-rank检验进行单因素分析，Cox比例风险回归模型进行多因素分析。59例MRD-中危AML患者中，男性27例、女性32例，中位年龄55（31~69）岁。所有患者中位随访时间761（317~1 861）d，2年总生存（OS）率、无事件生存（EFS）率分别为76.1%±11.4%、73.4%±11.6%。单因素分析结果显示年龄>50岁、TET2基因突变（TET2+）、MRD转阴时间>30 d（MRD30+）是影响患者OS的危险因素（χ²值分别为6.20、33.20、7.18，P值分别为0.013、<0.001、0.007），TET2+、WT1基因突变（WT1+）、输注CD34+细胞<2×106/kg、MRD30+是影响患者EFS的危险因素（χ²值分别为17.29、4.47、3.94、9.39，P值分别为<0.001、0.035、0.047、0.002）。多因素分析结果显示MRD30+、TET2+是影响接受auto-HSCT的MRD-中危AML患者OS及EFS的独立危险因素（OS：HR分别为9.251、25.839，P值分别为0.036、0.001；EFS：HR分别为5.851、9.199，P值分别为0.043、0.002）。MRD30+、TET2+是影响接受auto-HSCT的MRD-中危AML患者OS及EFS的独立危险因素，MRD30+、TET2+患者预后差，auto-HSCT后生存率低，需要进一步探索有效的治疗方案。.