THE RELATIONSHIP BETWEEN THE ABSOLUTE VALUE OF PERIPHERAL BLOOD LYMPHOCYTES IN PATIENTS WITH ACUTE MYELOID LEUKEMIA +21 DAYS AFTER ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION AND RECURRENCE AND OTHER CLINICAL EFFICACY

Liang Liang^*, Honghua He, Qinghua Li, Donghui Zheng, Jie Long, Jingzhi Ma 

Department of Hematology, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, PR China

Objective: To analyze the relationship between the absolute value of peripheral blood lymphocytes (ALC21) and recurrence and other clinical efficacy +21 days after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with acute myeloid leukemia (AML). 

Methods: AML patients undergoing allo-HSCT admitted to the Department of Hematology in our hospital from January 2015 to January 2020 were retrospectively reviewed. 4 ml of fasting venous blood was collected from all patients 21 days after transplantation. The absolute value of peripheral blood lymphocytes (ALC21) of all patients was detected using flow cytometry. According to their ALC21 levels, they were divided into an ALC21 high-expression group (ALC21≥0.50×10⁹/L, n=63) and an ALC21 low-expression group (ALC21<0.50×10⁹/L, n=43). All patients were followed up for five years, and indicators including the recurrence rate, overall survival rate (OS), Epstein–Barr virus (EBV) infection, cytomegalovirus (CMV) infection, acute graft-versus-host disease (aGVHD), and disease-free survival rate (DFS) were counted. The correlation between ALC21 and two-year OS and DFS was analyzed using Pearson linear correlation, and the relationship between ALC21 level and recurrence and other clinical efficacy in AML patients after allo-HSCT was analyzed. 

Results: The total infection rate of patients in the ALV21 high-expression group was 33.33%, which was significantly lower than the 62.79% in the ALC21 low-expression group, and the difference was statistically significant (P<0.05). There was no significant difference in ERV and CMV infection between the two groups (P>0.05). Out of a total of 106 patients in this experiment, 25 patients developed acute graft-versus-host disease (aGVHD) with a total incidence of 23.58%; there were 10 cases of grade I-II aGVHD with an incidence rate of 9.43%; and there were 14 cases of grade III-IV aGVHD with an incidence rate of 13.21%. The rate of aGVHD in the ALC21 high-expression group was 17.46%, which was significantly lower than the rate of 32.56% in the ALC21 low-expression group. The difference was statistically significant (P<0.05). This experiment was followed up for up to five years after transplantation and found that the post-transplant survival rate was 61.32%, and the post-transplant recurrence rate was 23.10%. Among them, 45 patients (71.43%) in the ALC21 high-expression group survived for five yearshigh-expression, and the post-transplant recurrence rate was 13.33%. Twenty patients (46.51%) in the ALC21 low-expression group survived for five years, and the recurrence rate after transplantation was 45.00%. The five-year survival rate, two-year OS, and DFS in the ALC21 high-expression group were significantly higher than those in the ALC21 low-expression group, and the five-year recurrence rate in the ALC21 high-expression group was significantly lower than that of the ALC21 low-expression group, and the difference was statistically significant (P<0.05). ALC21 was significantly positively correlated with two-year OS and DFS (r=0.526, 0.612, and P values were both <0.01 or <0.05). 

Conclusion: The ALC21 level after allo-HSCT in AML patients is closely related to the patient's infection, aGVHD occurrence, two-year OS, and DFS, which can predict the disease recurrence and prognosis after transplantation early, and can be widely used in clinical practice.