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Allogeneic hematopoietic stem cells transplantation improves the survival of intermediate-risk acute myeloid leukemia patients aged less than 60 years

  • Ying Zhang
  • Yimin Zhang
  • Qi Chen
  • Gusheng Tang
  • Weiping Zhang
  • Jianmin Yang
  • Jianmin Wang
  • Xiaoxia HuEmail author
Original Article

Abstract

The prognosis of acute myeloid leukemia (AML) with normal karyotype is further determined by specific genetic alterations. The optimal post-remission therapy (PRT) in younger patients within this group after first complete remission (CR1) remains to be determined. We report a retrospective evaluation of PRT approaches in 223 patients under the age of 60 years old with intermediate-risk AML in CR1. Patients receiving allogenic hematopoietic stem cell transplantation (alloHSCT) obtained improved overall survival (OS) than patients who treated with chemotherapy (5-year 61.6 ± 5.2% versus 41.1 ± 5.3%, p = 0.004). AlloHSCT led to fewer cases of relapse (hazard ratio [HR] 0.14, p < 0.001) and increased the relapse-free survival (RFS, HR 0.45, p < 0.001). With alloHSCT, the outcome of patients who reached negative minimal residual disease after 2 cycles of consolidation could be further improved with an increased OS of 66% and RFS of 61%. Nucleophosmin-1 (NPM1) mutation negative, CCAAT/enhancer binding protein alpha (CEBPA) double mutation negative, and FLT-3 internal tandem duplication negative (NPM1mut-negCEBPAdm-negFLT3-ITDneg) patients had a significantly longer RFS with alloHSCT. In conclusion, our results provide additional evidence that alloHSCT is preferential PRT in patients with intermediate-risk AML that are under the age of 60 years old in CR1.

Keywords

Acute myeloid leukemia Intermediate risk Postremission therapy Allogeneic hematopoietic stem cell transplantation NPM1mut-negCEBPAdm-negFLT3-ITDneg 

Notes

Authors’ contribution

Y.Z. collected and reviewed patient information, analyzed and interpreted the data, and wrote the manuscript; Y.M.Z. and Q.C. performed the statistical analysis; G.T. performed the molecular analysis; W.Z. and J.Y. performed the diagnosis and treatment for patients; J.W. and X.H. designed the study, interpreted the data, and critically reviewed the manuscript. All authors reviewed and approved the manuscript.

Funding

This work was supported by the National Natural Science Foundation of China (NSFC; 81770160, 81470321, 81270567, 81530047). X.H. was sponsored by Municipal Human Resources Development Program for Outstanding Leaders in Medical Disciplines in Shanghai (2017BR012).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this retrospective study, formal content is not required.

Supplementary material

277_2018_3584_MOESM1_ESM.pdf (461 kb)
Supplementary Table 1 (PDF 460 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Hematology, Institute of HematologyChanghai HospitalShanghaiChina
  2. 2.Department of Health StatisticsSecond Military Medical UniversityShanghaiChina

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