Umbilical cord blood transplantation can overcome the poor prognosis of KMT2A-MLLT3 acute myeloid leukemia and can lead to good GVHD-free/relapse-free survival
Open Access
- 20 January 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Annals of Hematology
- Vol. 100 (5), 1303-1309
- https://doi.org/10.1007/s00277-021-04413-2
Abstract
This is a retrospective study comparing the effectiveness of umbilical cord blood transplantation (UCBT) and chemotherapy for patients in the first complete remission period for acute myeloid leukemia with KMT2A-MLLT3 rearrangements. A total of 22 patients were included, all of whom achieved first complete remission (CR1) through 1–2 rounds of induction chemotherapy, excluding patients with an early relapse. Twelve patients were treated with UCBT, and 10 patients were treated with chemotherapy after 2 to 4 courses of consolidation therapy. The 3-year overall survival (OS) of the UCBT group was 71.3% (95% CI, 34.4–89.8%), and that of the chemotherapy group was 10% (95% CI, 5.89–37.3%). The OS of the UCBT group was significantly higher than that of the chemotherapy group (P = 0.003). The disease-free survival (DFS) of the UCBT group was 60.8% (95% CI, 25.0–83.6%), which was significantly higher than the 10% (95% CI, 5.72–35.8%) of the chemotherapy group (P = 0.003). The relapse rate of the UCBT group was 23.6% (95% CI, 0–46.8%), and that of the chemotherapy group was 85.4% (95% CI, 35.8–98.4%), which was significantly higher than that of the UCBT group (P < 0.001). The non-relapse mortality (NRM) rate in the UCBT group was 19.8% (95% CI, 0–41.3%), and that in the chemotherapy group was 0.0%. The NRM rate in the UCBT group was higher than that in the chemotherapy group, but there was no significant difference between the two groups (P = 0.272). Two patients in the UCBT group relapsed, two died of acute and chronic GVHD, and one patient developed chronic GVHD 140 days after UCBT and is still alive, so the GVHD-free/relapse-free survival (GRFS) was 50% (95% CI, 17.2–76.1%). AML patients with KMT2A-MLLT3 rearrangements who receive chemotherapy as their consolidation therapy after CR1 have a very poor prognosis. UCBT can overcome the poor prognosis and significantly improve survival, and the GRFS for these patients is very good. We suggest that UCBT is a better choice than chemotherapy for KMT2A-MLLT3 patients.Keywords
Funding Information
- Fundamental Research Funds for the Central Universities (WK9110000109)
- Key Research and Development Projects of Anhui Province (202004j07020019)
This publication has 20 references indexed in Scilit:
- Myeloablative Haploidentical Transplantation Is Superior to Chemotherapy for Patients with Intermediate-risk Acute Myelogenous Leukemia in First Complete RemissionClinical Cancer Research, 2019
- Panoramic view of common fusion genes in a large cohort of Chinese de novo acute myeloid leukemia patientsLeukemia & Lymphoma, 2018
- Outcome of allogeneic hematopoietic stem-cell transplantation for adult patients with AML and 11q23/MLL rearrangement (MLL-r AML)Leukemia, 2015
- Comparison of Conditioning Regimens with or without Antithymocyte Globulin for Unrelated Cord Blood Transplantation in Children with High-Risk or Advanced Hematological MalignanciesTransplantation and Cellular Therapy, 2015
- Novel prognostic subgroups in childhood 11q23/MLL-rearranged acute myeloid leukemia: results of an international retrospective studyBlood, 2009
- Umbilical cord blood transplantation: Basic biology and clinical challenges to immune reconstitutionClinical Immunology, 2008
- Myeloablative unrelated cord blood transplantation for adult acute myeloid leukemia patients with 11q23 abnormalitiesEuropean Journal of Haematology, 2008
- AML with 11q23/MLL abnormalities as defined by the WHO classification: incidence, partner chromosomes, FAB subtype, age distribution, and prognostic impact in an unselected series of 1897 cytogenetically analyzed AML casesBlood, 2003
- Transplant-related mortality and long-term graft function are significantly influenced by cell dose in patients undergoing allogeneic marrow transplantationBlood, 2002
- Cellular drug resistance in childhood acute myeloid leukemia is related to chromosomal abnormalitiesBlood, 2002