Clinical Analysis Of Hematopoietic Stem Cell Transplantation For 51 Cases Of Adult Acute Myeloid Leukemia-CR1

Objective To compare the efficacy of autologous hematopoietic stem cell transplantation (Auto-HSCT) with allogeneic hematopoietic stem cell transplantation (Allo-HSCT) in Acute myeloid leukemia in complete remission the first time (AML-CR1) of adult patients, analysis of the factors that affect the efficacy.Methods 51 adult patients with AML-CR1 in our hospital were involved ,all patient receive hematopoietic stem cell transplantation from 2000 May to 2008 July. The median age was 36.6 years (15～60 y).Cases were divided into two treated groups : autologous hematopoietic stem cell transplantation (Auto-HSCT) group (n=18) and allogeneic hematopoietic stem cell transplantation (Allo-HSCT) group (n=33). Allo-HSCT group include two subgroups: matched related donor (MRD)(n=26) and matched unrelated donor (MUD) (n=7).The regular intrathecal injection with two or three of methotrexate (MTX), cytarabine (Ara-C), dexamethasone (Dex) was used to prevention of CNSL.For the Pretreatment two case use TBI in each group,16 case use MAC program in Auto-HSCT group and 31 case use Maryland (BU) and cyclophosphamide (CY) in Allo-HSCT group.Each group of patients with clinical features and treatment prognosis were studied retrospectively, using t test measurement data. Using Kaplan-Meier method to calculate the survival rate, survival curve drawn. Comparison of survival by log-rank test method, using COX regression model analysis of multiple prognostic factors.All patients were followed up to 1 November, 2008. The median follow-up period was 29.7 months.Results All patients get Hematopoietic reconstitution, there was significant difference for the hematopoietic reconstitution time in two group (P <0.05). The 3-year leukemia-free-survival (LFS) of auto-SCT group and allo-SCT group was 65 % and 63 % respectively, no statistical significance (P > 0.05) exists; for relapse rate (RR) and transplantrelated morta lity (TRM), difference exists(P < 0.05), comparing with auto-SCT group, allo-SCT group has lower RR, higher TRM; Statistically, no difference between MRD group and MUD group appears in 3- leukemia-free- survival (LFS),RR and TRM (P > 0.05). Multivariate analysis showed that the age of pre-transplant,time of therapy and after treatment were the prognostic factors.Conclusion For patients with AML-CR1, allo-SCT and auto-SCT approximately have the same LFS. patients with allo-SCT have lower RR, higher TRM than patients with auto-SCT. For allo-SCT no difference exists in LFS,RR and TMR between MRD group and MUD group. the age of pre-transplant,time of therapy and after treatment were the prognostic factors. The better effectiveness can been acquired when the Auto-HSCT as the first choice for AML-CR1 period.