Objective: To investigate the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the treatment of acute monocytic leukemia (AML-M5) and the related factors that affecting the prognosis of the patients.
Methods: The clinical data of 71 patients with AML-M5 treated with allo-HSCT in Zhujiang Hospital Affiliated to Southern Medical University from April 2009 to October 2019 were collected and retrospectively analyzed. The incidence of graft-versus-host disease (GVHD), cumulative overall survival (OS) rate, cumulative progression-free survival (PFS) rate, transplantation-related mortality (TRM), relapse rate and the risk factors affecting prognosis in the patients were analyzed.
Results: 66 patients obtained hematopoietic reconstruction after transplantation, the median time of granulocyte implantation was 12 (9-26) d, and the median time of megakaryocytic implantation was 13 (8-72) d. The incidence of acute GVHD and chronic GVHD was 33.8% (24/71) and 36.6% (26/71), respectively. The median follow-up time was 13.81 (0.16 to 112.54) months; the median OS and PFS was 31.27 and 26.07 months, respectively. The cumulative OS of the patients in 1 and 3 years after transplantation was 64.9% and 48.6%, respectively, and the cumulative PFS of the patients in 1 and 3 years was 55.0% and 39.5%, respectively. The cumulative relapse rate of the patients in 1 and 3 years was 24% and 40%, respectively. Multivariate analysis showed that pre-transplantation relapse was the independent risk factor affecting OS (HR=2.32, 95%CI:1.17-4.62, P=0.02) and PFS (HR=3.08, 95%CI:1.61-5.90, P=0.001) of the patients; invasive fungal disease after transplantation was the independent risk factor affecting OS (HR=2.71, 95% CI:1.32-5.56, P=0.007) and PFS (HR=2.87, 95%CI=1.40-5.86, P=0.004) of the patients; FLT3 mutation was the independent risk factor affecting PFS (HR=2.13, 95%CI=1.07-4.24, P=0.03) of the patients.
Conclusion: AML-M5 is the intermediate or high-risk leukemia, and allo-HSCT can improve the survival prognosis of the patients. Pre-transplantation relapse and invasive fungal disease after transplantation are the important factors affecting the efficacy of allo-HSCT in patients with AML-M5.
题目: 异基因造血干细胞移植治疗急性单核细胞白血病患者的疗效及预后分析.
目的: 探讨异基因造血干细胞移植（allo-HSCT）治疗急性单核细胞白血病（AML-M5）患者的疗效及影响预后的相关因素.
方法: 收集2009年4月至2019年10月于南方医科大学珠江医院行allo-HSCT治疗的AML-M5患者71例的临床资料。分析患者移植物抗宿主病发生率、移植后累积总生存（OS）率、累积无进展生存（PFS）率、移植相关死亡（TRM）率、复发率以及影响预后的危险因素.
结果: 移植后，66例患者获得造血重建，粒系植入中位时间12（9-26）d，巨核系植入中位时间13（8-72）d。急、慢性移植物抗宿主病的发生率分别为33.8%（24/71）和36.6%（26/71）。中位随访时间为13.81（0.16-112.54）个月；中位OS和PFS时间分别为31.27和26.07个月。移植后1年和3年累积OS率分别为64.9%和48.6%，1年和3年累积PFS率分别为55.0%和39.5%。1年和3年累计复发率分别为24%和40%。多因素分析显示，移植前复发是影响患者OS（HR=2.32，95%CI:1.17-4.62，P=0.02）和PFS（HR=3.08，95%CI:1.61-5.90，P=0.001）的独立危险因素；移植后真菌感染是影响患者OS（HR=2.71，95%CI:1.32-5.56，P=0.007）和PFS（HR=2.87，95%CI:1.40-5.86，P=0.004）的独立危险因素；FLT3突变是影响患者PFS（HR=2.13，95%CI=1.07-4.24，P=0.03）的独立危险因素.
结论: AML-M5属于中高危白血病，allo-HSCT能改善患者的生存及预后。移植前复发和移植后真菌感染是影响allo-HSCT疗效的重要因素.