骨髓增生异常综合征转化为继发性急性髓系白血病的危险因素

Risk Factors for Transforming Myelodysplastic Syndromes into Secondary Acute Myeloid Leukemia

目的探讨骨髓增生异常综合征(MDS)转化为继发性急性髓系白血病(sAML)的危险因素。方法系统性回顾分析2016年6月到2019年9月就诊于郑州大学第一附属医院血液科的258例成年MDS患者的临床实验室检查结果以及MDS转化为sAML的危险因素。结果将258例成年MDS患者分为MDS未转化组(218例)与MDS转化组(40例)。MDS转化组中性粒细胞绝对值>0.8、血清乳酸脱氢酶>245 U·L^(-1)、外周血原始细胞数≥1%、骨髓原始细胞数≥5%、外周血细胞3系减少占比均高于MDS未转化组(P<0.05)。MDS转化组免疫表型CD71、CD123、HLA-DR阳性表达率均高于MDS未转化组(P<0.05)。MDS转化组SRSF2、TET2、DNMT3A、FLT3基因突变率均高于MDS未转化组(P<0.05)。多因素logistic回归分析结果显示,骨髓原始细胞数≥5%、SRSF2、TET2、DNMT3A、FLT3基因突变是MDS转化为sAML的危险因素(P<0.05)。结论骨髓原始细胞数≥5%、SRSF2、TET2、DNMT3A、FLT3基因突变是MDS转化为sAML的危险因素。

Objective To investigate the risk factors for transforming myelodysplastic syndromes(MDS)into secondary acute myeloid leukemia(sAML).Methods The clinical laboratory examination results of 258 adult patients with MDS and risk factors for transforming into sAML in the Department of Hematology of the First Affiliated Hospital of Zhengzhou University from June 2016 to September 2019 were analyzed systematically.Results The 258 adult patients with MDS were divided into MDS non-transformation group(218 cases)and MDS transformation group(40 cases).The proportions of neutrophil absolute value>0.8,serum lactate dehydrogenase>245 U·L^(-1),number of blast cells in peripheral blood≥1%,number of blast cells in bone marrow≥5%and peripheral blood cell line 3 reduction in MDS transformation group were all higher than those in MDS non-transformation group(P<0.05).The positive expression rates of immunophenotype CD71,CD123 and HLA-DR in MDS transformation group were all higher than those in MDS non-transformation group(P<0.05).The gene mutation rates of SRSF2,TET2,DNMT3A and FLT3 gene in MDS transformation group were all higher than those in MDS non-transformation group(P<0.05).Multivariate logistic regression analysis showed that the number of blast cells in bone marrow≥5%,SRSF2,TET2,DNMT3A and FLT3 gene mutation were the risk factors for transforming MDS into sAML(P<0.05).Conclusion The number of blast cells in bone marrow≥5%,SRSF2,TET2,DNMT3A and FLT3 gene mutation are the risk factors for transforming MDS into sAML.