急性白血病MAGE-A3基因表达的临床意义

Expression of MAGE-A3 Gene in Acute Leukemia and Its Clinical Significance

【目的】探讨MAGE-A3基因在急性白血病(AL)的表达及临床意义。【方法】初发AL93例,其中急性淋巴细胞白血病(ALL)27例、急性髓细胞白血病(AML)66例,采用逆转录-聚合酶链反应(RT-PCR)方法检测MAGE-A3基因的表达,观察该基因表达与初治患者治疗效果关系。【结果】93例AL中MAGE-A3基因阳性表达45例,总阳性率48.4%,其中在ALL、AML的阳性率分别为51.9%和47.0%,两组比较无统计学差异。在非M3型AML患者中,MAGE-A3表达阳性与阴性的完全缓解(CR)率分别为64.0%和92.3%,两者比较有统计学差异(P<0.05)。对表达阳性的21例AL治疗后MAGE-A3基因表达动态观察,当获得CR时,MAGE-A3表达可转阴性,持续阳性者可早期复发;未获CR者可持续表达阳性。【结论】MAGE-A3基因在AL中有一定的表达,在AML和ALL的表达率相仿。MAGE-A3基因阳性非M3型AML治疗CR率较低,MAGE-A3基因阳性表达可作为AML患者预后不良的一项指标。监测MAGE-A3基因表达变化可作为检测微小残留病的有效手段。

[Objective] To study the expression of MAGE-A3 gene in acute leukemia and its clinical significance. [Methods] Ninety-three newly diagnosed patients with acute leukemia （AL） including 27 acute lymphoblastic leukemia （ALL） and 66 acute myelogenous leukemia （AML）. Expression of MAGE-A3 mRNA was detected in these patients by reverse transcriptase polymerase chain reaction （RT-PCR）. The relationship between MAGE-A3 expression and response were analyzed. [Results] The expression of MAGE-A3 was positive in 45 of 93 AL patients （48.4%）. The positive rates of MAGE-A3 expression were 51.9% in ALL and 47.0% in AML, with no statistically significant difference. The complete remission （CR） rates were 64.0% in MAGE-A3- positive non-M3 AML patients and 92.3% in MAGE-A3-negative non-M3 AML patients, with statistically significant difference （P 〈 0.05）. Twenty-one patients with positive MAGE-A3 expression were followed up to observe the changes of MAGE-A3 expression after treatment. The MAGE-A3 could turn negative after getting CR. The patients who had gotten CR could relapse earlier when the MAGE-A3 was continent positive. The MAGE-A3 positive expression did not turn negative when the patients did not get CR. [ Conclusions ] MAGE-A3 expression is observed in some AL patients. The positive expression of MAGE-A3 is similar between AML and ALL. The non-M3 AML patients with positive MAGE-A3 expression got lower CR rate, which indicates that MAGE-A3 can be used as a poor prognostic factor in AML. Monitoring of the MAGE-A3 expression may be a useful means for the detection of minimal residual disease in AL.