Prognostic analysis of peripheral blood stem cell transplantation in the treatment of adult acute lymphoblastic leukemia
Objective To study the recurrence and survival status of allogeneic hematopoietic stem cell transplantation(Allo-HSCT)in the treatment of adult acute lymphoblastic leukemia(ALL).Methods A retrospective analysis was conducted on clinical data of 52 ALL patients who achieved complete hematological remission(CR1)after chemotherapy from January 2017 to June 2022.A modified BU/CY±ATG myeloablative pretreatment regimen was administered,and hematopoietic stem cells were derived from peripheral blood of related donors.Transplant related complications were reviewed,and risk factors for hematological relapse and survival status were analyzed.Results The white blood cell reconstruction time was 14(10-19)days,and the platelet reconstruction time was 16(11-25)days.After transplantation,18 cases(34.6%)developed acute graft-versus-host disease(aGVHD),15 cases(28.8%)developed chronic graft-versus-host disease(cGVHD),33 cases(63.5%)had cytomegalovirus(CMV)infection,and 10 cases(19.2%)developed hemorrhagic cystitis.Univariate analysis revealed that recurrence after Allo-HSCT was not related to patient gender,age,blood type,human leukocyte antigen(HLA)typing,occurrence of GVHD,CMV infection,or hemorrhagic cystitis(P＞0.05),but was associated with the degree of minimal residual disease(MRD)before transplantation,with a higher recurrence rate in MRD positive cases(P＜0.05).The patients were followed up until June 2023,with a median time of 38(4-69)months.The 3-year cumulative recurrence rate,disease-free survival(DFS)and overall survival(OS)were 31.6%,56.7%,64.3%,respectively;and the 5-year cumulative recurrence rate,DFS and OS were 37.3%,52.0%,59.0%,respectively.Conclusion Allo-HSCT from related donors can significantly improve the clinical outcome of ALL patients.Patients positive for MRD before transplantation have a higher recurrence rate.
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