| [Subject]To investigate the therapeutic effects of routine chemotherapy,microtransplantation,autologous hematopoietic stem cell therapy and allogeneic hematopoietic stem cell therapy in favorable-risk adults with acute myeloid leukemia.[Methods]A total of 204 cases of non-refractory adult AML from January 2010 to June 2017 in single-center were enrolled in the study,and the differences in recurrence rate and survival time between the patients receiving different treatment were compared.[Results]Among 204 patients,102 were male and 102 were female,the median age was 38(18/60)years old.In 204 patients,the cytogenetic analysis showed that 68 patients with t(8;21),50 patients were accompanied by t(16;16)/inv(16),46 patients with CEB PA allele double mutation and 40 patients with NPM1 mutation.They were divided into 4 groups:chemotherapy group(67 patients),microtransplantation group(36 patients),allo-HSCT(74 patients)and auto-HSCT group(27 patients).The age distribution of microtransplantation group was larger than that of other groups,and the difference was significant.At the end of follow-up,36 patients recurred,with a median recurrence time of 13.3(1.4/51.6)months.Among 67 cases in chemotherapy group,19 cases recurred,and the 5-year CIR was 39.8%.In the autotransplantation group,6 cases recurred,the 5-year CIR was 22.2%.In 74 cases of allogeneic transplantation,4 cases recurred,the 5-year CIR was 6.2%.Of 36 patients in the microtransplantation group,7 relapsed,with an estimated 5-year CIR of 20.8%.There was a significant difference in the cumulative recurrence rate(CIR)among the four groups(P=0.001).A total of 25 cases of NRM,were found in 204 patients,the median time was 11.5(2.3/59.9)months.In the 67 cases of chemotherapy group,8 cases developed NRM,5-year NRM was 14.3%;in the 27 cases of autotransplantation group,3 cases developed NRM,5-year NRM was 17.0%;in 74 cases of allogeneic transplantation,10 cases developed NRM,5-year NRM was 17.3%;in the microtransplantation group,4 of 36 patients developed NRM,5-years estimated NRM was 11.8%.There was no significant difference in NRM among the four groups(P=0.930).The estimated 5-year EFS rates in chemotherapy group,microtransplantation group,autotransplantation group and allogeneic transplantation group were 45.9%,67.3%,60.8%and 76.5%,respectively.Compared with different treatment groups,EFS in Allo-HSCT group was better than that in Chemo group(P=0.001),and the difference was statistically significant.The rate of EFS in MST group was better than that in Chemo group(P=0.069),but the EFS in MST,Auto-HSCT,Allo-HSCT group was similar(P>0.05).The estimated 5-year OS rates in chemotherapy group,microtransplantation group,autotransplantation group and allogeneic group were 52.3%,82.9%,62.0%and 77.3%,respectively.OS in Allo-HSCT,MST group was better than that in Chemo group(P<0.05),and OS in Auto-HSCT group was similar to that in Chemo group(P>0.05).[Conclusion]1.Compared with HD-Ara-C consolidation chemotherapy,Allo-HSCT significantly reduced the recurrence rate and improved EFS rate,is still the primary means of controlling recurrence.However,NRM is relatively high.With the progress of transplantation technique,direct transplantation in CR1 needs further study.2.Autologous transplantation(Auto-HSCT)has the same therapeutic effect as HD-Ara-C consolidation chemotherapy,and can be used as a choice for AML consolidation therapy in low-risk group.3.Microtransplantation(MST)is more beneficial than HD-Ara-C chemotherapy,with low CIR,and low treatment-related mortality is especially suitable for older patients and should be recommended.4.The prognosis of AML in the low risk group is heterogeneous,and the long-term recurrence rate is about 40%～50%.Therefore,the therapy is needed to further improve the radical cure rate based on the risk stratification. |
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