骨髓增生异常综合征患者免疫疗法反应性的比较

Correlation between SF3B1 gene mutation and immunotherapy response in patients with myelodysplastic syndrome

目的分析基因突变与骨髓增生异常综合征(MDS)患者免疫疗法反应性的相关性;方法选取67例骨髓增生异常综合征的患者为研究对象,根据患者免疫疗法的反应性分为反应组(n=29例)和无反应组(n=38例),对比2组患者的临床资料,实验室资料,基因突变情况,并应用Kaplan-Meier法绘制患者24个月的生存曲线;应用单因素和多因素Logistic回归模型分析影响MDS患者免疫疗法反应性相关危险因素。结果随访24个月,反应组患者的生存率为96.77%,无反应组患者的生存率为73.68%,2组比较差异具有统计学意义(P<0.05);2组患者原始细胞、骨髓增生程度、核型、细胞遗传学、CD4+/CD8+比值比较,差异无统计学意义(P>0.05);IPSS-R高危、HLA-DR15阳性明显高于无反应组,2组比较差异具有统计学意义(P<0.05);2组患者ASXL1、TET2、EZH2、STAG2、ZRSR2、IDH2、KDM6A、SETBP1、GATA2、RAD21、WT1、GNAS的基因突变比较差异无统计学意义(P>0.05);年龄>50岁(OR=3.021,P<0.05),IPSS-R(OR=7.875,P<0.05),RARS(OR=18.261,P<0.05),HLA-DR15(OR=2.917,P<0.05),SF3B1(OR=20.364,P<0.05)为影响MDS患者免疫疗法反应性相关危险因素;RARS(OR=9.537,P<0.05),SF3B1(OR=15.489,P<0.05)为影响MDS患者免疫疗法反应性的独立危险因素。结论MDS患者免疫疗法反应性与年龄>50岁、IPSS-R高危型、HLA-DR15、RARS型、SF3B1基因突变具有临床相关性,且RARS型、SF3B1基因突变是影响MDS患者免疫疗法反应性的独立危险因素。

Objective To analyze the correlation between the SF3B1 gene mutation and immunotherapy response in patients with myelodysplastic syndrome.Methods A total of 67 patients with myelodysplastic syndrome who treated were selected as the research objects,and patients were divided into reactive group(n=29)and non-reactive group(n=38)according to the responsiveness of immunotherapy.Clinical data,laboratory data,gene mutation status of the two groups of patients were compared.The Kaplan-Meier method was used to draw the patient’s 24-month survival curve;single factor and multivariate logistic regression models were used to analyze the risk factors that affect the immunosuppressive therapy responsiveness of MDS patients.Results Following-up for 24 months,the survival rate of patients in the response group was 96.77%,and the survival rate of patients in the non-response group was 73.68%.The survival rate of patients in the response group was significantly higher than the survival rate of patients in the non-response group,and the difference was statistically significant(P<0.05).There was no statistically significant difference between the two groups of patients in blasts,bone marrow hyperplasia,karyotype,cytogenetics,and CD4+/CD8+ratio(P>0.05).The RARS type of patients in the response group was significantly lower than that in the non-response group,while the IPSS-R low-risk and HLA-DR15 positive were significantly higher than those in the non-response group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the gene mutations of ASXL1,TET2,EZH2,STAG2,ZRSR2,IDH2,KDM6A,SETBP1,GATA2,RAD21,WT1,GNAS between two groups of patients(P>0.05).The number of patients with SF3B1 gene mutation in the response group was significantly more than that in the non-response group(P<0.05).The results of univariate logistic regression analysis showed that age>50 years(OR=3.021;P<0.05),IPSS-R(OR=7.875;P<0.05),RARS(OR=0.248;P<0.05),HLA-DR15(OR=0.326;P<0.05),SF3B1(OR=18.261;P<0.05)were related risk factors that affect the responsiveness of immunotherapy response in MDS patients.Multivariate logistic regression analysis showed that RARS(OR=0.217;P<0.05)and SF3B1(OR=15.896;P<0.05)were independent risk factors affecting the responsiveness of immunotherapy response in MDS patients.Conclusion The immunotherapy responsiveness of MDS patients is clinically correlated with age>50 years,IPSS-R high-risk type,HLA-DR15,RARS type,and SF3B1 gene mutations,and RARS type and SF3B1 gene mutations affect immunotherapy therapy in MDS patients Independent risk factors for reactivity.