NPM1突变阳性AML患者化疗后早期微小残留病水平与预后的关系

Correlation of Early Minimal Residual Disease Level with Prognosis in AML Patients with NPM1 Mutation Positive after Chemotherapy

目的:分析NPM1基因突变阳性的急性髓系白血病(AML)患者经化疗后,早期微小残留病水平与患者预后状况的相关性。方法:收集本院112例NPM1基因突变阳性的初诊成人AML患者的临床资料,分析患者化疗后NPM1基因突变转录本水平与患者预后状况的相关性。结果:在112例AML患者中,初诊时NPM1基因突变转录本中位水平为83.68%(5.86%-486.57%),FLT3-ITD突变阳性44例(39.29%),染色体核型异常22例(19.64%),完全缓解96例(85.71%);多因素Logistic回归分析结果发现,初始诱导治疗方案和白细胞计数(WBC)与完全缓解密切相关(P<0.05)。在112例患者中,中位随访时间为22(3-36)个月,3年总生存率为66.07%;多因素Logistic回归分析发现,在初次获得完全缓解时微小残留病高水平、巩固治疗后微小残留病高水平是患者总生存期的独立危险因素(P<0.05)。结论:在NPM1基因突变阳性的成人AML患者中,化疗后微小残留病早期高水平与患者预后不良密切相关。

Objective:To analyze the correlation of the minimal residual disease level with the prognosis of the AML patients with NPM1 gene mutation positive after chemotherapy.Methods:The clinical data of 112 newly diagnosed adult AML patients with positive NPM1 gene were collected and retrospectively analyzed.The correlation of the transcripts of NPM1 gene mutation with prognosis of patients was analyzed.Results:In 112 AML patients,the median transcript level of NPM1 gene mutation accounted for 83.68%(5.86%-486.57%),FLT3-ITD mutation positive was found in 44 cases(39.29%),chromosomal abnormalities in 22 cases(19.64%)and complete remission in 96 cases(85.71%).Multivariate logistic regression analysis showed that the initial induction therapy and white blood cell count closely related with complete remission(P<0.05).The median follow-up time was 22(3-36)months,and the 3-year overall survival rate was 66.07%in 112 patients.Multivariate logistic regression analysis showed that both the high level of minimal residual disease at the initial complete remission and the high level of minimal residual disease after consolidation therapy were the independent risk factors for overall survival(P<0.05).Conclusion:In newly diagnosed adult AML patients with NPM1 mutation positive,the early high level of minimal residual disease after chemotherapy closely relates with poor prognosis.