异基因造血干细胞移植治疗伴MLL基因重排急性髓系白血病47例预后分析

Prognostic analysis of allogeneic hematopoietic stem-cell transplantation in 47 patients with acute myeloid leukemia and MLL rearrangement

目的研究混合谱系白血病（MLL）基因重排阳性急性髓系白血病（AML）患者行异基因造血十细胞移植（allo—HSCT）的预后特点。方法回顾性分析2009年9月至2016年5月于苏州大学附属第一医院行allo-HSCT的47例MLL基因重排阳性AML患者的临床资料。结果全部47例MLL重排阳性AML患者中男24例，女23例，中位年龄30（15-58）岁，M4／M5共36例（76．6％）。移植后2年总生存（OS）率为（64．4±8．4）％，无病生存（DFS）率为（47．3±9．3）％，复发率为41．0％，移植相关死亡率为17．9％。45例患者检出11q23易位，2例染色体核型正常患者检mMLL部分串联重复。t（6：11）组（16例）、t（9；11）组（15例）、其他类型组（16例）的2年OS率差异无统计学意义（χ^2=1．509，P=0．472）。多因素分析显示，移植时年龄〉45岁是影响OS的独立危险冈素[HR=4．454（95％CI1．314-15．099），P=0．016]，移植前MRD阳性是影响患者DFS[HR=4．236（95％CI1．238-14．495），P=0．021]、复发[HR=5．491（95％C11．371-21．995），P=0．016]的独立不良预后因素，移植前疾病处于非CR状态患者移植相关死亡风险增高[HR=10．370（95％CI1．043—103．110），P=0．046]。结论移植时年龄〉45岁、移植前疾病处于非CR状态、移植前MRD阳性为影响allo—HSCT治疗MLL基因重排阳性AML患者预后的危险因素。

Objective To investigate the prognosis of allogeneic hematopoietic stem-cell transplantation （allo-HSCT） for patients with acute myeloid leukemia and MLL rearrangement. Methods From September 2009 to May 2016, the clinical data of 47 patients with MLL-rearranged AML undergoing allo-HSCT in the First Affiliated Hospital of Soochow University were retrospectively analyzed. Results Among 47 MLL-rearranged AML patients, 24 were male and 23 female. The median age was 30 （15-58） years old. There are 36 （76%） patients were FAB-types M4/M5. Two-year overall survival （OS）, disease- free survival （DFS）, relapse incidence and transplant-related mortality （TRM） were （64.4±8.4） %, （47.3±9.3） %, 41.0% and 17.9%, respectively. Of them, 45 patients were detected with 11 q23 translocations, and 2 patients with normal karyotype were MLL partial tandem duplication. According to different chromosome karyotype, 47 patients were divided into three groups： 16 cases of t （6; 11）, 15 cases of t （9; 11） and 16 cases of other types, bverall survival was compared between the three groups, there was no significant difference （χ^2 = 1.509, P = 0.472）. On multivariate analysis, independent risk factor on OS was transplant age 〉 45 years [HR = 4.454（95%C/ 1.314- 15.099）, P = 0.016]. The multivariate analysis also confirmed the higher TRM in patients at non-CR state when transplanted [HR = 10.370（95%CI 1.043-103.110）, P = 0.046]. Positive minimal residual disease （MRD） before transplantation was a negative prognostic factor on DFS -HR = 4.236（95% CI 1.238- 14.495）, P= 0.021] and relapse incidence （RI） [HR = 5.491（95% CI 1.371-21.995）, P=0.0161. Conclusion Transplant age （〉45 years）, allo-HSCT in non-CR state adn positive MRD before transplantation were negative prognostic factors in alIo-HSCT for MLL-rearranged AML patients.