四川地区AML1-ETO融合基因与急性髓系白血病临床特征的相关性及预后因素分析

Correlations Between AML1-ETO Fusion Gene and Clinical Features of Acute Myeloid Leukemia in Sichuan

目的分析四川地区AML1-ETO融合基因与急性髓系白血病(acute myeloid leukemia,AML)临床特征的相关性,探讨AML-M2型患者预后影响因素。方法选取AML1-ETO融合基因阳性AML-M2患者94例与AML1-ETO融合基因阴性AML-M2患者51例,回顾性比较分析其临床特征、治疗反应,并随访观察两组患者的预后情况。结果与AML1-ETO融合基因阴性AML-M2患者相比,AML1-ETO融合基因阳性AML-M2患者的临床症状差异无统计学意义(P>0.05),主要以贫血、发热、出血为主;两组患者的红细胞(RBC)、血小板(PLT)、粒红比、粒系(NC)%、CD34、人类白细胞DR抗原(HLA-DR)、CD56、CD19差异有统计学意义(P<0.05),数据的中位数值除RBC、PLT偏低外,其余均偏高;两组患者疗效与生存曲线分布差异无统计学意义(P>0.05);在AML-M2患者的长期生存影响因素分析中,CD56、骨髓原粒细胞百分比是长期生存的不利因素,完全缓解因素对长期生存有利。结论四川地区AML1-ETO融合基因阳性AML-M2人群与阴性人群相比,临床症状无特异,除部分血液、骨髓、流式实验数据有差异外,其他临床特征相似。两组患者的生存分析和预后也无明显差异,AMLM2疗效和预后影响因素多,准确评价AML1-ETO的预后诊断作用,应采用分层分析。

Objective To determine the correlations between AML1-ETO fusion gene and clinical characteristics of patients with AML, and its association with the prognosis of AML-M2. Methods Medical records of 94 AML-M2 cases with positive AML1-ETO fusion gene and 51 AML-M2 cases with negative AML1-ETO gene were retrospective reviewed. Their clinical characteristics, treatment responses and prognostic outcomes were compared. Results No significant differences in the clinical symptoms, predominantly anemia, fever and hemorrhage, were found between the AML1-ETO fusion gene positive and negative AML-M2 （P 〉 0. 05）. However,lower levels of red blood cell （RBC） and platelet （PLT）, and higher levels of ratio of grain to red, percentage of bone marrow granulocyte （NC）, CD34, human leukocyte antigen DR （HLA-DR）, CD56 and CD19 were found in those with positive AML1-ETO fusion gene （P〈0. 05）. The efficacy of treatments and survival curves showed no significant differences between the two groups （P〉0.05）. CD56 and original percentage of bone marrow granulocyte were predictors of poor long-term survival. Complete remission was the only predictor of better long-term survival. Conclusion AML1-ETO fusion gene is neither associated with clinical symptoms, nor with survival and long term prognosis in Sichuan. As many factors affect the efficacy of treatments and prognosis of AML-M2, stratified analysis is needed to determine the role of AML1-ETO.