急性髓系白血病(AML)患者的KMT2A重排(KMT2A-r)与不良预后相关;异基因造血干细胞移植(allo-HSCT)后的预后因素尚不清楚。我们调查了364名AML患者,他们在2016年4月至2022年5月期间接受了allo-HSCT,其中45名患有KMT2A-r。1:1匹配和最近邻匹配方法的倾向评分分析确定了KMT2A-r和非KMT2A-r队列中的42名患者,分别。2年总生存期(OS),无复发生存率(RFS),累积复发率(CIR),KMT2A-r患者(n=45)的非复发死亡率为59.1%,49.6%,41.5%,和8.9%,分别。使用倾向得分匹配,KMT2A-r患者的2年OS率(n=42)低于无KMT2A-r患者(n=42;56.1%vs88.1%,P=0.003)。在KMT2A-r患者中(n=45),在首次完全缓解(CR1)和可测量的残留病(MRD)阴性的移植中显示出预后优势,这反映在操作系统中,RFS,和CIR(分别为P<0.001,P<0.001和P=0.002)。此外,AF6患者的预后比AF9患者差,ELL,和其他KMT2A-r亚型(对于OS,P=0.032,P=0.001和P=0.001,RFS,和CIR,分别)。然而,在操作系统中没有发现差异,RFS,KMT2A-r有突变和无突变患者的CIR(均P>0.05)。单变量和多变量分析显示,在HSCT之前达到CR1MRD阴性是OS的保护因素[危险比(HR)=0.242,P=0.007],RFS(HR=0.350,P=0.036),和CIR(HR=0.271,P=0.021),AF6是RFS(HR=2.985,P=0.028)和CIR(HR=4.675,P=0.004)的危险因素。KMT2A-rAML患者预后较差,特别是那些有AF6相关易位的人;然而,它与突变的存在无关。这些患者可以受益于在HSCT之前实现CR1MRD阴性。
KMT2A rearrangement (
KMT2A-r) in patients with acute myeloid leukemia (AML) is associated with poor outcomes; the prognostic factors after allogeneic hematopoietic stem cell transplantation (allo-HSCT) remain unclear. We investigated 364 adults with AML who underwent allo-HSCT between April 2016 and May 2022, and 45 had KMT2A-r among them. Propensity score analysis with 1:1 matching and the nearest neighbor matching method identified 42 patients in KMT2A-r and non-
KMT2A-r cohorts, respectively. The 2-year overall survival (OS), relapse-free survival (RFS), cumulative incidence of relapse (CIR), and non-relapsed mortality rates of patients with KMT2A-r (n = 45) were 59.1%, 49.6%, 41.5%, and 8.9%, respectively. Using propensity score matching, the 2-year OS rate of patients with
KMT2A-r (n = 42) was lower than that of those without
KMT2A-r (n = 42; 56.1% vs 88.1%, P = 0.003). Among patients with
KMT2A-r (n = 45), the prognostic advantage was exhibited from transplantation in first complete remission (CR1) and measurable residual disease (MRD) negative, which was reflected in OS, RFS, and CIR (P < 0.001, P < 0.001, and P = 0.002, respectively). Furthermore, patients with AF6 had poorer outcomes than those with AF9, ELL, and other KMT2A-r subtypes (P = 0.032, P = 0.001, and P = 0.001 for OS, RFS, and CIR, respectively). However, no differences were found in the OS, RFS, and CIR between patients with KMT2A-r with and without mutations (all P > 0.05). Univariate and multivariate analyses revealed that achieving CR1 MRD negative before HSCT was a protective factor for OS [hazard ratio (HR) = 0.242, P = 0.007], RFS (HR = 0.350, P = 0.036), and CIR (HR = 0.271, P = 0.021), while AF6 was a risk factor for RFS (HR = 2.985, P = 0.028) and CIR (HR = 4.675, P = 0.004). The prognosis of patients with KMT2A-r AML was poor, particularly those harboring AF6-related translocation; however, it is not associated with the presence of mutations. These patients can benefit from achieving CR1 MRD negative before HSCT.