11q23/MLL阳性成人急性髓细胞白血病的临床特征及预后分析

Clinical features and prognosis of adult acute myeloid leukemia associated with 11q23/MLL

目的探讨11q23/MLL相关成人急性髓细胞白血病(AML)的临床特点及其预后。方法选取2012年1月～2018年1月于潍坊市人民医院血液内科住院的AML患者共400例,采用染色体、分子生物学检查11q23/MLL表达,分析其表达与患者临床特征、治疗效果及预后的关系。结果 11q23/MLL基因重排在成人AML中阳性率为5. 0%,44例对照组患者均未检测到11q23/MLL表达; 20例MLL阳性患中,MLL/AF4者1例,MLL/AF9者7例,MLL/AF19者4例,MLL/AF17者4例,MLL/AF10者2例,MLL/ELL者2例; 11q23/MLL在法美英协作组(FAB)分型各亚型所占比例不同,M4、M5比例最高; 11q23/ML阳性组患者较对照组患者初诊白细胞数高,化疗后缓解率低,复发率高,生存率低,预后差(P <0. 05)。结论 11q/23MLL在成人急性髓细胞白血病患者中存在一定的突变率,且多见于M4、M5型患者,11q/23MLL阳性患者具有外周血白细胞数高,缓解率低,复发风险高,预后差等特点。

Objective To investigate the clinical characteristics and prognosis of 11q23/MLL related adult acute myeloid leukemia. Methods From January 2012 to January 2018,400 adult patients with acute myeloid leukemia were selected from the Department of Hematology,Weifang People’s Hospital. The expression of 11q23/MLL was detected by chromosome and molecular biology,and the relationship between their expression and clinical characteristics,therapeutic effect and prognosis was analyzed. Results The positive rate of 11q23/MLL gene was 5. 0% in adult AML,and no 11q23/MLL was detected in 44 patients in the control group. Among the 20 cases of MLL positive,1was MLL/AF4,7 were MLL/AF9,4 were MLL/AF19,4 were MLL/AF17,2 were MLL/AF10 and 2 were MLL/ELL. 11q23/MLL is different in different subtypes of FAB,M4 and M5 have the highest proportion. 11q23/MLL positive group had higher initial white blood cell count than the control group,with low remission rate after standard treatment,high recurrence rate,low survival rate and poor prognosis( P < 0. 05). Conclusion 11q23/MLL in adult patients with acute myelogenous leukemia has certain mutation rate,and can be found in M4,M5 type patients,11q23/MLL positive patients is characterized by a high number of peripheral blood leukocytes,remission rate is low,the risk of recurrence is high,poor prognostic features.