Abstract: There was some heterogenity in low or intermediate risk acute myeloid leukemia (AML) stratified by European LeukemiaNet (ELN), the optimal post-remission treatment for an individual favorable and intermediate risk genetics AML patient has not yet been established. HLA-mismatched stem cell micro-transplantation (MST), a novel apporoach of transplantation, which may improve outcomes and avoid graft versus host disease (GVHD) in first complete remission (CR1) AML patients. We retrospectively analyzed the efficacy, safety and survival of the 63 patients with favorable or intermediate risk AML received MST, autologous stem cell transplantation (ASCT) or cytarabine single agent (CSA) as post-remission treatment from January 2014 to August 2021. Neutrophil recovery time was shorter in the MST group than CSA group. There was no significant difference in three groups of infection and bleeding. The 2-year cumulative incidences of relapse were 27.27%, 29.41% and 41.67% in the MST, ASCT and CSA groups, respectively. During the period of follow-up, there were 21 patients (33.3%) died to relapse, including 6(9.52%), 5(7.94%) and 10 (15.84%) deaths in MST, ASCT and CSA groups, respectively. The estimated overall survival (OS) and relapse free survival (RFS) at 2 years were 62.2% vs 50.0% (P = 0.101) and 57.1% vs 50.0% (P = 0.136) in MST and CSA group (P = 0.101) for patients over 60 years. The estimated OS at 2 years was 100.0%, 66.2%, and 69.1% in MST, ASCT and CSA group ( MST vs CSA, P = 0.044), meanwhile, the estimated RFS at 2 years was 100.0%, 65.4%, and 59.8% ( MST vs CSA, P = 0.050) in patients ≤ 60 years. We concluded that MST, ASCT and CSA were all acceptable options for favorable and intermediate risk AML patients as post-remission treatment. Moreover, MST could not only improve the prognosis of the elderly but also prolong the OS and RFS of low or intermediate-risk patients ≤ 60 years.
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