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) . ③ Probabilities 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) . ④ During 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) . ⑤ Univariate 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.
目的： 探讨移植前病程对急性髓系白血病（AML）患者异基因造血干细胞移植（allo-HSCT）预后的影响。 方法： 对2012年1月至2014年6月期间接受allo-HSCT的107例第1次完全缓解（CR(1)）期AML患者进行回顾性分析。 结果： ①移植前病程<6个月组46例，男25例，女21例，中位年龄26（12~60）岁；移植前病程≥6个月组61例，男34例，女27例，中位年龄31（14~58）岁。年龄、性别分布、NCCN危险分层、移植前达CR(1)疗程数、移植前MRD状态、移植类型及移植前感染发生率比较，两组差异均无统计学意义（P>0.05）。移植前病程<6个月、≥6个月组移植前中位化疗疗程数分别为4（3~5）、5（4~10）个（P=0.015）。②移植前病程<6个月、≥6个月组Ⅱ~Ⅳ度急性GVHD发生率分别为26.09%（12/46）、24.59%（15/61）（P=0.860），Ⅲ/Ⅳ度急性GVHD发生率分别为2.17%（1/46）、14.75%（9/61）（P=0.027）。③移植前病程<6个月组移植后2年总生存率、无病生存率均高于移植前病程≥6个月组[（90.3±4.6）%对（75.7±5.7）%，P=0.042；（90.7±4.4）%对（76.3±5.5）%，P=0.038]。④中位随访时间863（26~2 026）d，移植前病程<6个月组非复发死亡率低于移植前病程≥6个月组[（4.4±3.1）%对（18.2±5.0）%，P=0.047]。⑤单因素分析结果显示，移植年龄、NCCN危险分层、移植前MRD状态及移植前感染情况对预后均无影响。移植前化疗疗程（≤4个/>4个）对总生存率、无病生存率均有影响（P=0.044，P=0.039），对非复发死亡率无影响（P=0.079）。 结论： 移植前病程<6个月的CR(1)期AML患者可获得较好的allo-HSCT预后。.
Keywords: Acute myeloid leukemia; Hematopoietic stem cell transplantation; Prognosis.