摘要目的 研究混合谱系白血病(MLL)基因重排阳性急性髓系白血病(AML)患者行异基因造血干细胞移植(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出MLL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(x2=1.509,P=0.472).多因素分析显示,移植时年龄＞45岁是影响OS的独立危险因素[HR=4.454(95％CI 1.314～15.099),P=0.016],移植前MRD阳性是影响患者DFS [HR=4.236 (95％ CI 1.238～ 14.495),P=0.021]、复发[HR=5.491 (95％ CI 1.371～ 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％ CI 1.043～ 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.

abstractsObjective 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),diseasefree 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 1 lq23 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.Overall survival was compared between the three groups,there was no significant difference (x2 =1.509,P =0.472).On multivariate analysis,independent risk factor on OS was transplant age ＞ 45 years [HR =4.454(95％CI 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 =0.016].Conclusion Transplant age (＞ 45 years),allo-HSCT in non-CR state adn positive MRD before transplantation were negative prognostic factors in allo-HSCT for MLL-rearranged AML patients.