FLT3-ITD基因阳性急性髓系白血病的免疫表型及临床特征研究

Immunopphenotype and clinical features of acute myeloid leukemia with positive FLT3-ITD

目的探讨急性髓系白血病(AML)患者FMS样酪氨酸激酶3内部串联重复序列(FLT3-ITD)的免疫表型特征及血小板(PLT)、血红蛋白(Hb)水平等临床指标变化。方法选取广东医科大学附属医院血液内科2016年5月至2018年11月收治的140例AML患者为观察对象,其中FLT3-ITD阳性25例(阳性组),FLT3-ITD阴性115例(阴性组)。回顾性分析AML患者FLT3-ITD阳性及阴性的免疫表型,并观察临床指标特点,同时结合相关文献进行总结分析。结果与阴性组患者比较,阳性组患者免疫表型CD33、CD56、CD7表达率及外周血白细胞计数(WBC)、骨髓白血病细胞占比均明显升高,而CD117表达率明显降低,差异均有统计学意义(P<0.05);但两组患者的Hb及PLT水平比较,差异无统计学意义(P>0.05);阴性组患者的治疗总反应率高于阳性组患者(72.63%vs.40.91%),两组患者治疗总反应率比较差异有统计学意义(P<0.05)。结论AML患者的白血病细胞抗原与FLT3-ITD基因型有关,FLT3-ITD阳性患者的淋系抗原CD56、CD7及髓系抗原CD33均呈高表达,而髓系抗原CD117呈低表达,且治疗缓解率低。

Objective To observe the immunopphenotypic features of FMS-like tyrosine kinease 3-internal tandem duplication(FLT3-ITD)and the changes of clinical indexes,such as platelet(PLT)and hemoglobin(Hb)level,in patients with acute myelogenous leukemia(AML).Methods 140 AML patients admitted to the department of hematology of affiliated hospital of guangdong medical university from May 2016 to November 2018 were selected as the observation objects.Among them,25 cases were positive for FLT3-ITD(the positive group),and 115 cases were negative(the negative group).The immunophenotypes of AML patients with positive FLT3-ITD and negative FLT3-ITD were prospectively analyzed,and the characteristics of clinical indexeswere observed.At the same time,relevant literatures were combined for summary and discussion.Results The expression rates of immunopathotype CD33,CD56 and CD7,white blood cells(WBC)count and proportion of leukemia cells in peripheral blood of FLT3-ITD positive AML patients were higher than those of FLT3-ITD negative AML patients,while the expression rate of CD117 was lower,the differences were statistically significant(P<0.05).However,there was no significant change in Hb and PLT levels(P>0.05).The total response rate in FLT3-ITD negative patients was higher than those in FLT3-ITD positive patients(72.63%vs.40.91%),and the difference was statistically significant(P<0.05).Conclusion Leukemia cell antigen in AML patients is associated with genotype FLT3-ITD.In FLT3-ITD positive patients,lymphoid antigen CD56,CD7 and myeloid antigen CD33 show high expression,while myeloid antigen CD117 shows low expression and low remission rate.