title: The Superiority of Allogeneic Hematopoietic Stem Cell Transplantation Over Chemotherapy Alone in the Treatment of Acute Myeloid Leukemia Patients with Mixed Lineage Leukemia (MLL) Rearrangements.
abstract: BACKGROUND Acute myeloid leukemia (AML) patients with mixed lineage leukemia (MLL) gene rearrangements always had a very poor prognosis. In this study, we report the incidence of MLL rearrangements in AML patients using gene analysis, as well as the clinical significance and prognostic features of these rearrangements. MATERIAL AND METHODS This retrospective study took place from April 2008 to November 2011 in the People's Liberation Army General Hospital. A total 433 AML patients were screened by multiple nested reverse transcription polymerase chain reaction (RT-PCR) to determine the incidence of the 11 MLL gene rearrangements. There were 68 cases of MLL gene rearrangements, for a positive rate of 15.7%. A total of 24 patients underwent allogeneic hematopoietic stem cell transplantation (Allo-HSCT), and 34 patients received at least 4 cycles of chemotherapy. Ten patients were lost to follow-up. RESULTS The median follow-up was 29 months. The complete remission (CR) rate was 85.4%. The overall survival (OS) was 57.4±5.9 months for the Allo-HSCT group and 21.0±2.1 months for the chemotherapy group. The Allo-HSCT group had superior survival compared with the chemotherapy group (5-year OS: 59±17% vs. 13±8%, P<0.01; 5-year disease-free survival [DFS]: 65±10% vs. 40±16%, P>0.05). Multivariate analysis showed that transplantation, platelets >50×10^9/L at onset, and CR are associated with a better OS in MLL rearranged AML patients. Patients with thrombocytopenia and extramedullary involvement were prone to relapse. CONCLUSIONS Our results suggest that Allo-HSCT is superior to chemotherapy alone for treating MLL rearranged AML patients. Patients treated with Allo-HSCT have a better prognosis and a longer survival. CR is an independent prognostic factor for OS, and extramedullary involvement is an independent prognostic factor for DFS. MLL rearranged AML patients with thrombocytopenia at onset <50×10^9 had very bad OS and DFS.
authors.affiliation: Department of Hematology and BMT, Chinese PLA General Hospital, Beijing, China (mainland).
authors.forename: Hua
authors.initials: H
authors.lastname: Yang
authors.affiliation: Department of Hematology and BMT, Chinese PLA General Hospital, Beijing, China (mainland).
authors.forename: Sai
authors.initials: S
authors.lastname: Huang
authors.affiliation: Department of Hematology and BMT, Chinese PLA General Hospital, Beijing, China (mainland).
authors.forename: Cheng-Ying
authors.initials: CY
authors.lastname: Zhu
authors.affiliation: Department of Hematology and BMT, Chinese PLA General Hospital, Beijing, China (mainland).
authors.forename: Li
authors.initials: L
authors.lastname: Gao
authors.affiliation: Department of Hematology and BMT, Chinese PLA General Hospital, Beijing, China (mainland).
authors.forename: Hai-Yan
authors.initials: HY
authors.lastname: Zhu
authors.affiliation: Department of Hematology and BMT, Chinese PLA General Hospital, Beijing, China (mainland).
authors.forename: Na
authors.initials: N
authors.lastname: Lv
authors.affiliation: Department of Hematology and BMT, Chinese PLA General Hospital, Beijing, China (mainland).
authors.forename: Yu
authors.initials: Y
authors.lastname: Jing
authors.affiliation: Department of Hematology and BMT, Chinese PLA General Hospital, Beijing, China (mainland).
authors.forename: Li
authors.initials: L
authors.lastname: Yu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006412:Hematopoietic Stem Cells; D006801:Humans; D015456:Leukemia, Biphenotypic, Acute / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D014184:Transplantation, Homologous / Q000379:methods