title: [Analysis of Risk Factors and Therapeutic Strategies for Relapse of Leukemia after Allogeneic Hematopoietic Stem Cell Transplantation].
abstract: OBJECTIVE
  To analyze the risk factors of patients with relapsed leukemia after allogeneic hematopoietic stem cell transplantation, and to explore the therapeutic strategies for recurrence.
  
  
  METHODS
  The Cox proportional hazard regression model was used for univariate and multivariate analysis of transplantation-related index, a single center retrospective study of clinical data of 202 cases of leukemia received allo-HSCT from March 2004 to October 2014 had been conducted to screen the risk factors for recurrence after transplantation.
  
  
  RESULTS
  In the leukemia patients received allo-HSCT, 68 cases relapsed. The relapse rate was 33.6%. The median time of relapse was 4(1.5-26 ) months. Univariate analysis indicated that there were 5 risk factors related with the disease relapse(P<0.05), including the type of disease, extramedullary disease prior to transplant, the course of induced remission, the status of disease at HSCT and chronic graft versus host disease(cGVHD). Multivariate analysis showed that extramedullary disease prior to transplant(RR=2.622, 95%CI 1.139-6.037), the course of induced remission(RR=1.156, 95%CI 0.682-1.957), cGVHD (RR=1.728,95%CI 0.999-2.991) were independent risk factors for relapse of the patients received transplantation. Treatment strategies for the relapsed patients included withdraw immunosuppressant, donor lymphocyte infusion, systemic chemotherapy and local radiotherapy, targeted therapy, and second transplantation. Individualized choice was needed according to the relapsed site. The relapse-related mortality was 25.2%.
  
  
  CONCLUSIONS
  The relapsed patients with leukemia after allo-HSCT have poor prognosis, early interference has good effect. The evaluation and prevention of risk factors before transplantation is even more important.
authors.affiliation: Department of Hematology, General Hospital of Chinese Air Force, Beijing 100142, China.
authors.forename: Xiao-Yan
authors.initials: XY
authors.lastname: Shu
authors.affiliation: Department of Hematology, General Hospital of Chinese Air Force , Beijing 100142, China.
authors.forename: Xia-Fang
authors.initials: XF
authors.lastname: Yan
authors.affiliation: Department of Hematology, General Hospital of Chinese Air Force , Beijing 100142, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Dong
authors.affiliation: Department of Hematology, General Hospital of Chinese Air Force , Beijing 100142, China.
authors.forename: Li
authors.initials: L
authors.lastname: Ding
authors.affiliation: Department of Hematology, General Hospital of Chinese Air Force , Beijing 100142, China.
authors.forename: Dong-Mei
authors.initials: DM
authors.lastname: Han
authors.affiliation: Department of Hematology, General Hospital of Chinese Air Force , Beijing 100142, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Xue
authors.affiliation: Department of Hematology, General Hospital of Chinese Air Force , Beijing 100142, China.
authors.forename: Zhi-Dong
authors.initials: ZD
authors.lastname: Wang
authors.affiliation: Department of Hematology, General Hospital of Chinese Air Force , Beijing 100142, China.
authors.forename: Hong-Min
authors.initials: HM
authors.lastname: Yan
authors.affiliation: Department of Hematology, General Hospital of Chinese Air Force , Beijing 100142, China.
authors.forename: Heng-Xiang
authors.initials: HX
authors.lastname: Wang
authors.affiliation: Department of Hematology, General Hospital of Chinese Air Force , Beijing 100142, China.E-mai: duanlianning@hotmail.com.
authors.forename: Lian-Ning
authors.initials: LN
authors.lastname: Duan
mesh_terms: D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents; D007938:Leukemia; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents