Analysis On The Effectiveness Of Allogeneic Hematopietic Stem Cell Transplantation In The Treatment Of AML1-ETO-positive Acute Myeloid Leukemia (M2 Subtype)

Objective:To analyse the clinical effect of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in AML1-ETO-positive acute myeloid leukemia(M2).Methods:Clinical data of 20 patients with AML1-ETO-positive acute myeloid leukemia (M2) receiving allo-HSCT in General Hospital of Air Force from Jul.2007 to Sep.2014 were retrospectively analyzed. Of them,9 patients underwent haploidentical HSCT (Haplo-HSCT), and 11 patients received grafts from HLA-matched donors. All patients accepted myeloablative conditioning regimen. Univariate and multivariate analysis was carried out for overall survival (OS), disease-free survival (DFS), relapse rate (RR) and transplant-related mortality(TRM).Results:All patients achieved neutrophil engraftment successfully. The median time for neutrophil recovery was 15.5 days (11-26 days). Successful platelet engraftment was found in 19 patients, while one patient failed platelet recovery. The median time for platelet recovery was 17 days (11-34 days).The overall survival rate, disease-free survival rate and cumulative recurrence rate were 75%,70%,20% respectively. Univariate analysis showed that central nervous system leukemia prior to transplant had significant effect on TRM, DFS and OS (p<0.05) and the occurrence of acute GVHD only significantly affected TRM (p<0.05). Gender, age, initial white blood cell count, type of transplantation (unrelated donor or identical siblings or haploidentical), AML1-ETO content before transplantation, time interval from diagnosis to transplantation (≥6 month or <6 month), remission status (CR1, CR2 or no remission), use of mesenchymal stem cells, chronic GVHD, CMV infection after transplantation, pulmonary infection,hemorrhagic cystitis had little effect on TRM, RR, DFS and OS (p>0.05). Multivariate analysis demonstrated that male, central nervous system leukemia, the occurrence of pulmonary infection and hemorrhagic cystitis were unfavorable factors in relation to OS and central nervous system leukemia was unfavorable factors to DFS. Remission status before transplantation (CR1, CR2 or no remission) and the episode of chronic GVHD were favorable factors for RR.Conclusion:(1).Allogeneic hematopoietic stem cell transplantation is an effective therapeutic option for the treatment of AML-ETO-positive acute myeloid leukemia. (2).Central nervous system leukemia and transplant-related complications including pulmonary infections and severe hemorrhagic cystitis are unfavorable factors of overall survival. (3).The occurrence of chronic GVHD may reduce the risk of leukemia relapse.