Abstract:

Objective To investigate the efficacy and influencing factors of allo?HSCT in the treatment of MDS patients with ASXL1⁺. Methods The second?generation sequencing technique was used to detect 22 gene mutations in 247 newly diagnosed MDS patients in our hospital. The patients were divided into chemotherapy group and transplant group according to treatment style. The differences of OS and PFS between the two groups were compared， and the influencing factors of prognosis of transplant patients were analyzed. Results ASXL1+ was detected in 75 patients （30.36%）， with a median mutation ratio of 42.93 （18.10，58.39）%， 10 received supportive treatment， 43 received demethylation therapy or demethylation combined with pre?excitation therapy， and 22 received allo?HSCT. 2?year PFS rate and OS rate of transplantation group were significantly higher than that of chemotherapy group （P < 0.05）. The 2?year OS rate in the low ASXL1 mutation load group （VAF ≤ 42.93%） was significantly higher than that in the high ASXL1 mutation load group （VAF > 42.93%） （P < 0.05）. In the context of allo?HSCT in patients with ASXL1⁺， 2?year OS and PFS rates were significantly reduced in patients with RUNX1⁺ or ASXL1⁺ （P < 0.05）； Multivariate analysis showed that high mutation load of ASXL1 or U2AF1⁺ were independent risk factors for OS in transplant patient （P < 0.05）. U2AF1⁺ were the risk factors for PFS （P < 0.05）. Conclusion allo?HSCT significantly improved the prognosis of patients with ASXL1⁺ MDS. High ASXL1 mutation load or U2AF1⁺ were independent risk factors affecting the outcome of allo?HSCT.

Key words: myelodysplastic syndrome, allogeneic hematopoietic stem cell transplantation, ASXL1