影响RUNX1-RUNX1T1阳性AML患儿长期预后的相关因素

Related Factors Affecting Long-term Prognosis of AML Children with Positive RUNX1-RUNX1T1

目的:分析影响RUNX1-RUNX1T1阳性急性髓细胞白血病(AML)患儿长期预后的相关因素。方法:收集并回顾性研究2010年1月至2015年12月本院63例行BCH-AML 05方案治疗的RUNX1-RUNX1T1阳性AML患儿的临床资料。检测患儿初诊时(T1)、第1次诱导治疗后(T2)、第2次诱导治疗后(T3)、第1次巩固治疗后(T4)、第2次巩固治疗后(T5)及第3次巩固治疗后(T6)RUNX1-RUNX1T1融合转录本水平,并相应分为低表达组与高表达组,分组界值为10^4copies/10^4-葡萄糖苷酸酶(GUS)、10^3copies/10^4GUS、10^2copies/10^4GUS、10 copies/10^4GUS、1copies/10^4GUS、0 copies,将所得数据纳入统计学分析。结果:63例患儿随访期间死亡23例,其余40例患儿中位随访时间为30.04(11-60)个月。比较低表达组与高表达组的初诊患儿CD15检测阳性率,存在明显差异(P<0.05);而2组患儿性别、年龄、FAB分型、血小板(Plt)计数、血红蛋白(Hb)水平及白细胞(WBC)计数及T2时骨髓幼稚细胞数比例,均无明显差异(P>0.05)。单因素分析显示,性别、T1时Plt计数和T1、T2、T6时融合转录本水平与患儿5年总生存率有关(P<0.05)。多因素分析显示,T2时融合转录本水平>10^3copies/10^4GUS是影响患儿5年总生存率的独立危险因素(HR=2.13,95%CI:1.04-7.78)(P<0.05)。结论:RUNX1-RUNX1T1阳性AML患儿首次诱导治疗结束后融合转录本水平是患儿长期预后状况的独立影响因素。

Objective:To analyze the related factors affecting the long-term prognosis of acute myeloid leukemia(AML)children with positive RUNX1-RUNX1 T1.Methods:The clinical data of 63 chlidren with positive RUNX1-RUNX1 T1 AML treated by BCH-AML 05 regimen in our hospital from January 2010 to December 2015 were collected and analyzed retrospectively.The level of RUNX1-RUNX1 T1 was detected at the time of initial diagnosis(T1),after the first induction treatment(T2),after the second induction treatment(T3),after the first consolidation treatment(T4)after the second consolidation treatment(T5)and after the third consolidation treatment(T6).According to the fusion transcript levels of RUNX1-RUNX1 T1 the AML children were divided into low-expression group and high-expression group;the threshold values for grouping were 10^4 copies/10^4β-glucuronidase(GUS),10^3 copies/10^4 GUS,10^2 copies/10^4 GUS,10 copies/10^4 GUS,1 copies/104 GUS and 0 copies respectively.The gained data were enrolled in the statistical analysis.Results:23 cases of 63 children died during the follow-up period,and the median follow-up time of the remaining 40 children were 30.04(11-60)months.There were statistically significant differences in CD15 positive rate between low-expression group and high-expression group(P 0.05),however,there were no statistically significant differences in sex,age,FAB typing,platelet(Plt)count,hemoglobin(Hb)and white blood cell(WBC)count and the ratio of bone marrow immature cells at T2 between the two groups(P>0.05).Univariate analysis showed that sex,Plt counts at T1 and fusion transcript levels at T1,T2 and T6 correlated with the 5-year overall survival rate(P<0.05).Multivariate analysis showed that fusion transcript level10^3 copies/10^4 GUS at T2 was an independent risk factor for 5-year overall survival rate(HR=2.13,95%CI:1.04-7.78)(P<0.05).Conclusion:The fusion transcript level after the first induction therapy in RUNX1-RUNX1 T1-positive AML children is an independent factor influencing the long-term prognosis.