Objective: To analyze the effect of NCCN (2015) risk stratification on prognosis of patients with acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: Retrospective analysis of 258 patients with AML in CR (186 cases in CR(1), 72 cases in CR(2)) who underwent allogeneic HSCT in our hospital between April 2012 and March 2015 according to NCCN (2015) risk stratification. Of them, 63 cases were classified as low risk, 112 cases intermediate risk and 83 cases high risk. Results: ①With the median follow up of 18 (5-41) months, two-year disease free surviva (DFS) in 258 patients was 78.0% (95% CI 60.4%-96.6%) . Two-year DFS in AML after transplantation was 78.6% (95% CI 61.0%-96.2%) in low risk, 76.0% (95% CI 84.0%-93.6%) in intermediate risk and 80.3% (95% CI 62.7%-97.9%) (P=0.886) in high risk groups respectively. ②Univariate analysis showed that DFS has no significant difference in patient age, the median disease course before HSCT, the WBC number at the beginning of the disease, blood routine and chromosomes examination before transplantation, extramedullary disease before transplantation, disease status before transplantation, conditioning regimen, donor type, donor and recipient sex, recipient blood type, transfused MNC number, transfused CD34(+) cell number and transfused CD3(+) cell number. DFS was significant lower in primary AML than that in secondary AML (P=0.006) and also lower in MRD positive than that in MRD negative (P=0.003) . The accumulative relapse was significant higher in CR(2) compared to that in CR(1) (P=0.046) . Accumulative non-relapse mortality (NRM) was significanlyt higher in secondary AML compared to that in primary AML (P=0.004) and also higher in MRD positive compared to that in MRD negative (P=0.010) . ③Multivariate analysis showed that MRD positive was the only significant factor in DFS and NRM. Conclusion: Allo-HSCT treatment of AML CR patients could achieve a high efficacy, which is similar between CR(1) and CR(2) patients. There is no significant correlation between NCCN (2015) risk stratification and the prognosis of AML patients with allo-HSCT treatment. Pre-conditioning MRD status monitored by multiparameter flow cytometry was the only impact factor on DFS and NRM in allo-HSCT for CR-AML patients.
目的：分析NCCN（2015）危险分层对异基因造血干细胞移植（allo-HSCT）治疗的急性髓系白血病（AML）患者预后的影响。 方法：回顾性分析2012年4月至2015年3月完全缓解（CR）后行allo-HSCT治疗的258例AML患者资料（其中186例为CR(1)，72例为CR(2)）。按照NCCN（2015）危险分层对患者发病初始进行危险度分层，并分析该分层法对患者预后的影响。 结果： ①258例患者按照NCCN（2015）危险分层法分为低危组63例、中危组112例、高危组83例。中位随访18（5~41）个月，总体2年累积无病生存（DFS）率为78.0%，低、中、高危组分别为78.6%、76.0%、80.3%，三组差异无统计学意义（P=0.886）。②单因素分析结果显示，2年DFS率与NCCN危险分层、移植前病程、发病初WBC数、CR状态、移植前血常规是否恢复正常、移植前染色体是否正常、移植前是否有髓外病变、预处理方案、供者类型、供受者性别、供受者血型、输注的单个核细胞数、输注的CD34(+)细胞数、输注的CD3(+)细胞数等无相关性，在继发性AML（P=0.006）及MRD阳性（P=0.003）组患者中明显降低；2年累积复发死亡率在CR(2)（P=0.046）组患者中明显增高；2年累积非复发死亡（NRM）率在继发性AML（P=0.004）及MRD阳性（P=0.010）组患者中明显增高。③采用Cox回归模型进行多因素分析，结果显示MRD阳性是影响患者2年累积DFS率（HR=2.073，95%CI 1.124~3.822，P=0.020）、NRM率（HR=2.354，95%CI 0.804~6.887，P=0.045）的危险因素。 结论： allo-HSCT治疗CR的AML患者可取得较高疗效，其中CR(2)与CR(1)疗效相似；NCCN（2015）危险分层与allo-HSCT治疗的AML患者预后无显著相关性；预处理前多参数流式细胞术监测的MRD状态是影响allo-HSCT治疗的AML患者预后的主要因素。.
Keywords: Hematopoietic stem cell transplantation; Leukemia, myeloid, acute; National comprehensive cancer network; Risk assessment.