Effect of IA10 regimen induction therapy on newly diagnosed adult acute myeloid leukemia patients without allogeneic hematopoietic stem cell transplantation and the prognostic factor analysis / 白血病·淋巴瘤

ABSTRACT

Objective:To investigate the effect of IA10 regimen induction therapy on newly diagnosed adult acute myeloid leukemia (AML) patients without allogeneic hematopoietic stem cell transplantation (allo-HSCT) and the influencing factors of prognosis.Methods:The clinical data of 99 adult patients with newly diagnosed AML treated with IA10 regimen and without allo-HSCT in the Third Hospital of Yuncheng City in Shanxi Province from January 2007 to April 2017 were retrospectively analyzed. The baseline disease characteristics, relapse and survival status and minimal residual disease (MRD) levels were obtained. The influencing factors of prognosis were evaluated by Cox regression model.Results:All the 99 patients did not undergo allo-HSCT after achieved morphologic leukemia-free state (MLFS), the blood cells of 84 cases (84.8%) recovered to complete remission (CR) when reaching MLFS, 8 cases (8.1%) had CR with incomplete recovery of platelet count (CRp), 7 cases (7.1%) had CR with incomplete recovery of blood cell count (CRi). The median relapse time, median disease-free survival time, and median overall survival time were 35 months (6-54 months), 22 months (4-49 months) and 39 months (9-73 months). Multivariate analysis showed that FLT3-ITD was an independent risk factor for relapse, disease-free survival and overall survival in all patients and patients with consolidation therapy ≥1 course (all patients HR=3.46, 95% CI 2.03-5.97, HR=2.49, 95% CI 1.40-5.47, HR=2.70, 95% CI 1.86-5.90; patients with consolidation therapy ≥1 course HR=2.14, 95 CI 1.67-5.64, HR=2.63, 95 CI 1.54-5.03, HR=2.06, 95 CI 1.12-4.34; all P < 0.05); the high risk group of South West Oncology Group (SWOG) was an independent risk factor for relapse and disease-free survival in all patients ( HR=2.54, 95% CI 1.16-5.30; HR=2.57, 95% CI 1.38-5.10; both P < 0.05); CRi when achieving MLFS was an independent risk factor for disease-free survival and overall survival in all patients and patients with consolidation therapy ≥ 1 course (all patients HR=5.71, 95% CI 2.66-11.03, HR=4.46, 95% CI 2.51-9.14; patients with consolidation therapy ≥ 1 course HR=3.87, 95% CI 1.56-9.83, HR=4.67, 95% CI 2.33-11.59; all P < 0.05), and it was an independent risk factor for relapse in all patients ( HR=3.37, 95 CI 1.26-8.91, P < 0.01); the proportion of peripheral blood primitive cells ≥ 0.50 and the positive MRD after 1 course of consolidation therapy were the independent risk factors for relapse and disease-free survival in patients with consolidation therapy ≥ 1 course (proportion of peripheral blood primitive cells ≥ 0.50 HR=1.96, 95% CI 1.25-3.41, HR=1.56, 95% CI 1.02-2.94; positive MRD after 1 course of consolidation therapy HR=2.21, 95% CI 1.37-4.05, HR=2.46, 95% CI 1.51-4.23; all P < 0.05). There were significant differences in cumulative relapse, disease-free survival and overall survival of patients without and with 1, 2 and 3 prognostic risk factors (all P < 0.05). Conclusions:IA10 regimen is effective in the induction therapy of newly diagnosed adult AML patients without allo-HSCT. The poor molecular genetic characteristics and CRi when achieving MLFS at the first diagnosis are risk factors for the prognosis of patients, and the high proportion of peripheral blood primitive cells, the combination of monokaryotype and positive MRD after 1 course of consolidation therapy are also closely related to the poor prognosis of patients.