ABSTRACT
We aimed to improve the outcome of t(8;21) acute myeloid leukemia (AML) in the first complete remission (CR1) by applying risk-directed therapy based on minimal residual disease (MRD) determined by RUNX1/RUNX1T1 transcript levels. Risk-directed therapy included recommending allogeneic hematopoietic stem cell transplantation (allo-HSCT) for high-risk patients and chemotherapy/autologous-HSCT (auto-HSCT) for low-risk patients. Among 116 eligible patients, MRD status after the second consolidation rather than induction or first consolidation could discriminate high-risk relapse patients (P = .001). Allo-HSCT could reduce relapse and improve survival compared with chemotherapy for high-risk patients (cumulative incidence of relapse [CIR]: 22.1% vs 78.9%, P < .0001; disease-free survival [DFS]: 61.7% vs 19.6%, P = .001), whereas chemotherapy/auto-HSCT achieved a low relapse rate (5.3%) and high DFS (94.7%) for low-risk patients. Multivariate analysis revealed that MRD status and treatment choice were independent prognostic factors for relapse, DFS, and OS. We concluded that MRD status after the second consolidation may be the best timing for treatment choice. MRD-directed risk stratification treatment may improve the outcome of t(8;21) AML in CR1. This trial was registered at http://www.chictr.org as #ChiCTR-OCH-12002406.
Subject(s)
Chromosomes, Human, Pair 21/genetics , Chromosomes, Human, Pair 8/genetics , Leukemia, Myeloid, Acute/diagnosis , Leukemia, Myeloid, Acute/therapy , Translocation, Genetic , Adolescent , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Combined Modality Therapy , Consolidation Chemotherapy , Female , Hematopoietic Stem Cell Transplantation , Humans , Leukemia, Myeloid, Acute/genetics , Leukemia, Myeloid, Acute/mortality , Male , Middle Aged , Neoplasm, Residual , Prognosis , Remission Induction , Risk Assessment , Survival Analysis , Young AdultABSTRACT
The objective of study was to observe the efficacy and adverse events of modified CAG regimen in treating patients with relapsed acute myeloid leukemia. CAG regimen with prolongation of aclarubicin up to 7 days were used to treat 17 cases of relapsed acute myeloid. After 1 course of chemotherapy, the efficacy and adverse events were evaluated, patients who did not achieve remission were excluded from this regimen, patients who achieved remission were continuously given 1 course of CAG regimen. The results showed that out of 17 case 8 patients achieved complete remission (CR, 47.06%) and 5 patients achieved partial remission (PR, 29.14%). Most of these cases had slight adverse events which mainly were marrow suppression that could be tolerated, overall survival was 76.47%. In conclusion, treatment for relapsed acute myeloid leukemia with modified CAG regiment is safe and effective, and can provide conditions for allo-hematopoietic stem cell transplantation, but its long term efficacy needs to further study.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols , Leukemia, Myeloid, Acute/drug therapy , Aclarubicin , Cytarabine , Granulocyte Colony-Stimulating Factor , Humans , Treatment OutcomeABSTRACT
To investigate the clinical features and outcome of severe pneumonia after allogeneic hematopoietic stem cell transplantation for malignant hematological disease, the clinical features of severe pneumonia, including symptoms, signs, blood-gas analysis and thoracic X-ray change were observed, the clinical therapeutical outcome is also evaluated. The results showed that after treatment with antibiotics or antibiotics + antiviral drugs or antibiotics + antiviral drugs + glucocorticosteroids, as well as mechanical ventilation, pulmonary changes in 17 patients with sever pneumonia completely disappeared, 1 case died. In conclusion, early diagnosis and proper treatment for complicated pneumonia after allogeneic hematopoietic stem cell transplantation can decrease the mortality.
