BCR-ABL阴性骨髓增殖性肿瘤的基因特征研究

The genetic characteristics of BCR-ABL-negative myeloproliferative neoplasms

目的探讨JAK2、MPL和CALR驱动基因突变情况与BCR-ABL阴性骨髓增殖性肿瘤(MPN)的3种疾病类型[原发性骨髓纤维化(PMF)、真性红细胞增多症(PV)、原发性血小板增多症(ET)]选择间的关系。方法采用高通量测序靶向检测156例BCR-ABL阴性MPN患者的32种MPN相关基因,分析患者一般情况、驱动基因及伴随基因突变特点等因素与MPN疾病类型的关系。结果患者疾病类型与年龄关系的分析显示,在JAK2 V617F阳性状态下,PMF患者中60岁以上者的比例较高。通过高通量测序检测,在46例JAK2、MPL或CALR突变患者中检出22种伴随异常基因,其中PV 4例(8.3%),ET 20例(29.4%),PMF 22例(55.0%)。PV仅检出DNMT3A突变,而剪接因子相关基因SF3B1、SRSF2和U2AF1突变仅出现在PMF患者。根据JAK2 V617F突变的变异等位基因频率(VAF值)进行对比分析,结果显示,PV相关的VAF值最高(68.15%),其次为PMF(37.7%)和ET(23.0%),而MPN的3种疾病类型间JAK2 V617F纯合状态比例的差异有统计学意义。且在JAK2突变阳性状态下,PV和ET患者基因突变个数均明显低于PMF。结论MPN患者的年龄、驱动基因(JAK2、MPL和CALR)的突变特点(VAF值、纯合状态)以及伴随异常基因的种类和突变个数等因素,与驱动基因突变状态下MPN疾病类型的选择密切相关,其相关性有助于我们进一步认识MPN和早期评估疾病风险。

Objective To explore the relationship between driver gene mutation(JAK2,MPL and CALR)and disease type in BCR-ABL negative myeloproliferative neoplasms(MPNs)including primary myeloid fibrosis(PMF),essential thrombocytosis(ET)and polycythemia vera(PV).Methods A total of 32 MPN related genes were detected by high-throughput sequencing in 156 MPN patients.The relationships between disease type and patients′general performance,the characteristics of driver gene mutations,concomitant gene mutations were analyzed.Results In the population with JAK2 V617F positive mutation,the proportion of patients over 60 years old in PMF was higher than that with ET or PV.By high-throughput sequencing,22 concomitant gene mutations were detected in 46 patients with JAK2,MPL or CALR mutations,including 4(8.3%)in PV,20(29.4%)in ET,and 22(55.0%)in PMF.DNMT3A mutation was detected only in patients with PV,while splicing factor related genes including SF3B1,SRSF2 and U2AF1 were only accompanied by PMF.According to the variation allele frequency(VAF)value of JAK2 V617F mutation,the VAF value associated with PV was the highest(68.15%),followed by PMF(37.7%)and ET(23%).However,there were significant differences in the incidence of JAK2 V617F homozygous among 3 different diseases.In patients with JAK2 mutation,the proportion of other gene mutations in PV and ET was significantly lower than that in PMF.Conclusions Under the condition of common driver gene mutations(JAK2,MPL and CALR),patients′age,VAF value and homozygous state,concomitant gene mutations are closely related to different disease type.These correlations help to improve clinical understanding of disease characteristics and risk assessment.