[The comparison of predicting clinical outcomes between immunolophenotype and hematological complete remission before human leukocyte antigen-matched sibling donor transplantation in acute myeloid leukemia].

Objective: To assess the prognostic significance of immunophenotype complete remission (ICR) and hematological complete remission (HCR) before human-leukocyte antigen (HLA)-matched sibling donor transplantation (MSDT) in acute myeloid leukemia (AML) patients. Methods: A cohort of 182 AML (non-APL) patients undergoing MSDT in HCR was retrospectively studied [including complete remission with ANC and PLT recovery (CR), CR with incomplete PLT recovery (CRp), CR with inconplete ANC and PLT recovery (CRi)]; ICR was determined as undetective minimal resudial disease (MRD) by multi-parameter flow cytometer. Results: ①Of the 182 patients, 97 were male, 85 female, and the median age was 41(4-62) years. ②The CR and CRi+CRp rates were 80.8% (147/182) and 19.2%(35/182), respectively; The 4-year cumulative incidence of relapse[CIR, (11.0±4.3)% vs (16.0±7.1)%, χ (2)=0.274, P =0.600], non-relapse mortality[NRM, (14.0±4.3)% vs (9.0±6.3)%, χ (2)=0.913, P =0.339], leukemia-free survival[LFS, (75.0±5.1)% vs (75.0±8.3)%, χ (2)=0.256, P =0.613], and overall survial [OS, (77.0±5.2)% vs (80.0±8.1)%, χ (2)=0.140, P =0.708] were comparable between the CRp+CRi and CR groups. ③Compared with the non-ICR group ( n =35), the ICR group ( n =147) showed lower 4-year CIR [(11.3±3.4) % vs (55.2±8.8) %, χ (2)=32.687, P <0.001], better 4-year LFS [(76.2±4.7)% vs (32.8±8.7)%, χ (2)=26.234, P <0.001] and OS[(79.0±4.7)% vs (39.0±9.1)%, χ (2)=25.253, P <0.001], and comparable NRM[(12.5±4.1)% vs (12.0±7.1)%, χ (2)=1.002, P =0.656]. ④Mulitvariate analysis confirmed the independent prognostic value of ICR in lower CIR [ HR =11.026(95% CI 4.685-25.949), P <0.001], higher LFS [ HR =5.785 (95% CI 2.974-11.254), P <0.001] and OS[ HR =5.578 (95% CI 2.575-27.565), P <0.001]. Conclusion: The results indicated that ICR instead of HCR pre-transplantation had a significant prognostic value in AML patients undergoing MSDT.