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Flow Cytometry to Estimate Leukemia Stem Cells in Primary Acute Myeloid Leukemia and in Patient-derived-xenografts, at Diagnosis and Follow Up
Published on: March 26, 2018
[Clinical Analysis for Patients with AML Treated after Allo-HSCT]
Qing-Yun Wang1, Yu-Jun Dong1, Ze-Yin Liang1
1Department of Hematology, Peking University First Hospital, Beijing 100034, China.
Insights
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) improves survival for acute myeloid leukemia (AML) patients, but relapse remains a challenge. Maintenance therapy with hypomethylation agents and donor lymphocyte infusion (DLI) shows promise for relapsed AML post-transplant.
Area of Science:
- Hematology
- Oncology
- Transplantation Medicine
Background:
- Acute myeloid leukemia (AML) survival has improved with allogeneic hematopoietic stem cell transplantation (allo-HSCT).
- Relapse remains a significant factor impacting long-term survival in AML patients post-allo-HSCT.
- Identifying risk factors and effective salvage therapies for relapsed AML is crucial.
Purpose of the Study:
- To identify risk factors influencing survival and relapse in AML patients undergoing allo-HSCT.
- To investigate therapeutic strategies for managing AML relapse after allo-HSCT.
Main Methods:
- Retrospective analysis of clinical data from 180 AML patients who achieved complete remission before allo-HSCT.
- COX regression analysis was employed to determine risk factors for survival and relapse.
Main Results:
- The 5-year overall survival (OS), event-free survival (EFS), and cumulative relapse rates were 74.3%, 42.5%, and 25.0%, respectively.
- Independent risk factors for OS included high-risk status, adverse cytogenetics, CR2 at HSCT, and absence of cGvHD.
- High-risk status, MRD positivity, adverse cytogenetics, and absence of cGVHD were associated with relapse; hypomethylation agents plus DLI improved OS in relapsed patients (2-year OS 62.5%).
Conclusions:
- Allo-HSCT significantly enhances AML survival, yet relapse remains a primary determinant of patient outcomes.
- Maintenance therapy combining hypomethylation agents with donor lymphocyte infusion (DLI) presents a potential effective treatment for relapsed AML post-allo-HSCT.
Objective:
To analyze risk factors that affect survival and relapse of AML patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and to investigate the therapy choices after AML relapse.
Methods:
Clinical data of 180 AML patients achieved complete remission (CR) before HSCT from January 2009 to December 2018 treated in our center were analyzed retrospectively. Risk factors for survival and relapse after allo-HSCT were analyzed by COX regression.
Results:
Among 180 AML patients, 134 survived (74.4%), 46 patients died (25.6%), and 40 patients relapsed (22.2%). The rate of overall survival (OS), event-free survival (EFS) and cumulative rate of relapse in 5-years was 74.3%、42.5% and 25.0%, respectively. High-risk, adverse cytogenetics, CR2 at HSCT and no cGvHD were independent risk factors that affect OS. CR2 at HSCT, high-risk were independent risk factors that affect EFS. High-risk, MRD+ after one course of induction therapy, adverse cytogenetics and no cGVHD were independent risk factors that affect relapse. The OS rate of relapse patients could be improved by the usage of hypomethylation agents combined with G-CSF mobilized donor lymphocyte infusion (DLI), and 2-year OS rate was 62.5%.
Conclusion:
The survival rate of AML is greatly improved by allo-HSCT, but relapse is still one of the most important factors that influence survival of the AML patients. The maintenance therapy of hypomethylation agents combined with DLI may be a new effective treatment option for patients who relapse after HSCT.
