高超二倍体、三/四倍体染色体核型在急性髓细胞白血病中的预后意义

Prognostic significance of high hyperdiploid and triploid/tetraploid acute myeloid leukemia

目的描述高超二倍体、三/四倍体染色体核型急性髓细胞白血病(HH/TT-AML)患者的生物学特征,探讨其与预后的关系。方法回顾性分析2006年3月至2017年6月28例HH/TT-AML初治患者一般临床特征、治疗情况,用Kaplan-Meier方法分析预后影响因素。结果 HH/TT-AML患者核型以49条染色体为主,占39.3%(11/28),50～55条染色体次之,占32.1%(9/28)。高超二倍体核型急性髓细胞白血病(HH-AML)患者以+8(77.3%,17/22)、+21(54.5%,12/22)多见。生存分析显示,伴-5/5q-、-7/7q-、-17/der(17p)及der(3q)的HH/TT-AML患者总体生存率劣于不伴此类异常者(4.1月vs 10.1月,P<0.05);三/四倍体染色体核型急性髓细胞白血病(TT-AML)患者总体生存率与HH-AML患者差异无统计学意义(8.4月vs 7.2月,P>0.05);异基因造血干细胞移植患者总体生存率优于仅化疗患者(25.4月vs 4.1月,P<0.01)。结论 HH/TT-AML患者存在较大异质性,不良预后相关染色体异常的识别有助于预后分层。此类患者总体生存期短,联合化疗获缓解后尽早行异基因造血干细胞移植能显著改善患者预后。

Objective To investigate the biological characteristics of high hyperdiploid and triploid/tetraploid acute myeloid leukemia (HH/TT-AML) and its relationship with prognosis. Methods The clinical data of 28 patients with newly diagnosed HH/TT-AML during March 2006 and June 2017 were retrospectively analyzed, and the factors influencing prognosis were analyzed by the Kaplan-Meier method. Results The karyotypes of HH/TT-AML patients were mainly 49 chromosomes, accounting for 39.3%(11/28), followed by 50-55 chromosomes, accounting for 32.1%(9/28). The karyotypes of high hyperdiploid acute myeloid leukemia (HH-AML) patients were more likely to be +8 (77.3%, 17/22) or +21 (54.5%, 12/22). The survival analysis showed that the overall survival rate of HH/TT-AML patients with -5/5q-,-7/7q-,-17/der(17p) or der(3q) was significantly lower than that without these abnormalities (4.1 months vs 10.1 months, P <0.05). There was no significant difference in the overall survival rate between triploid/tetraploid acute myeloid leukemia (TT-AML) patients and HH-AML patients (8.4 months vs 7.2 months, P >0.05). The overall survival rate of the patients with allogeneic hematopoietic stem cell transplantation was significantly longer than that with chemotherapy alone (25.4 months vs 4.1 months, P <0.01). Conclusion HH/TT AML patients are highly heterogeneous. The identification of poor prognosis-related chromosome abnormalities is helpful for the stratification of prognosis. The overall survival time of these patients is short. Early allogeneic hematopoietic stem cell transplantation after remission by combination chemotherapy can significantly improve the prognosis of these patients.