title: Improved outcome with hematopoietic stem cell transplantation in a poor prognostic subgroup of patients with mixed-lineage-leukemia-rearranged acute leukemia: Results from a prospective, multi-center study.
abstract: The purpose of this study is to define the role for allogeneic hematopoietic stem cell transplantation (allo-HSCT) in mixed-lineage-leukemia (MLL)-rearranged acute leukemia, which is now poorly understood. A prospective, multi-center cohort study to determine whether allo-HSCT could decrease relapse rates and improve long-term survival of MLL+ leukemia patients was performed. Fifty-six consecutive patients diagnosed with MLL-rearranged acute leukemia undergoing allo-HSCT from two transplant centers in China were enrolled between October 2007 and October 2012. The trial was registered at www.chictr.org as # ChiCTR-ONC-12002739. The incidences of grades II to IV acute graft versus host disease (aGVHD) and of grades III and IV aGVHD were 28.8% (CI, 16.87-40.8%), and 14.2% (CI, 5.4-23.0%), respectively. The cumulative incidences for chronic GVHD (cGVHD) at 2 years after HSCT were 35.2% (CI, 21.2-49.2%). Up to April 30, 2013, 12 patients had relapsed and 11 died from relapse, and 37 patients were still alive without disease recurrence. The relapse and NRM rates at 3 years were 25.3% (CI, 12.7-37.9%) and 18.0% (CI, 2.6-33.4%), respectively. The probalities of overall survival and leukemia free survival were 61.8% (CI, 46.0-77.6%) and 56.3% (CI, 38.1-74.5%) at 3 years, respectively. Patients transplanted during their hematological first complete remission (CR1) had a lower relapse rate (17.9% vs. 48.1%, P = 0.03) compared with patients transplanted beyond CR1. The median overall survival for the 29 patients not receiving allo-HSCT during the study period was 145 days from diagnosis. This study showed that allo-HSCT could be a valuable treatment choice for MLL+ acute leukemia.
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Peking University People's Hospital, Institute of Hematology, Beijing, People's Republic of China.
authors.forename: Wang
authors.initials: W
authors.lastname: Yu
authors.forename: Qi-Fa
authors.initials: QF
authors.lastname: Liu
authors.forename: Liu
authors.initials: L
authors.lastname: Qi-Fa
authors.forename: Ya-Zhen
authors.initials: YZ
authors.lastname: Qin
authors.forename: Qin
authors.initials: Q
authors.lastname: Ya-Zhen
authors.forename: Dai-Hong
authors.initials: DH
authors.lastname: Liu
authors.forename: Liu
authors.initials: L
authors.lastname: Dai-Hong
authors.forename: Lan-Ping
authors.initials: LP
authors.lastname: Xu
authors.forename: Xu
authors.initials: X
authors.lastname: Lan-Ping
authors.forename: Bin
authors.initials: B
authors.lastname: Jiang
authors.forename: Jiang
authors.initials: J
authors.lastname: Bin
authors.forename: Qian
authors.initials: Q
authors.lastname: Jiang
authors.forename: Jiang
authors.initials: J
authors.lastname: Qian
authors.forename: Min
authors.initials: M
authors.lastname: Dai
authors.forename: Dai
authors.initials: D
authors.lastname: Min
authors.forename: Si-Jian
authors.initials: SJ
authors.lastname: Yu
authors.forename: Yu
authors.initials: Y
authors.lastname: Si-Jian
authors.forename: Xin-Miao
authors.initials: XM
authors.lastname: Jiang
authors.forename: Jiang
authors.initials: J
authors.lastname: Xin-Miao
authors.forename: Yan-Rong
authors.initials: YR
authors.lastname: Liu
authors.forename: Liu
authors.initials: L
authors.lastname: Yan-Rong
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Huang
authors.forename: Huang
authors.initials: H
authors.lastname: Xiao-Jun
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018890:Chemoprevention; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D015456:Leukemia, Biphenotypic, Acute / Q000235:genetics / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D014019:Tissue Donors; D014178:Translocation, Genetic; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult