急性单核细胞白血病的临床特点及预后分析

Analysis of clinical features and prognostic factors of acute monocytic leukemia

目的:探讨急性单核细胞白血病(AML-M5)的主要临床特点及预后影响因素。方法:回顾性分析2014年01月至2019年01月我院59例初诊AML-M5患者的临床资料,与癌症基因组图谱(TCGA)数据库22例患者的临床特点进行对比分析,并分析可能影响我院患者预后的重要因素。结果:与TCGA数据库相比,我院M5b亚型较多(78.0%vs 36.4%,P=0.000);中位骨髓原始细胞比例较低(69%vs 83%,P=0.006);我院NPM1突变较少(25.4%vs 54.5%,P=0.013),DNMT3A突变较少(8.5%vs 50%,P=0.000);我院患者与TCGA数据库单纯化疗患者OS差异无统计学意义(P=0.379);单因素分析显示年龄、白细胞计数、初次诱导缓解程度、FLT3-ITD突变、NPM1突变但不伴FLT3-ITD突变及预后危险分层与预后明显相关(P<0.05);多因素分析表明年龄、白细胞计数、初次诱导缓解程度及预后危险分层是影响预后的独立危险因素(P<0.05)。结论:AML-M5的预后与年龄、白细胞计数、初次诱导缓解程度及预后危险分层相关。

Objective:To investigate the main clinical features and prognostic factors of acute monocytic leukemia(AML-M5).Methods:Retrospectively analyze the clinical data of 59 newly diagnosed AML-M5 patients in our hospital from January 2014 to January 2019,and compare with the clinical characteristics of 22 patients in the Cancer Genome Atlas(TCGA)database.The factors affecting the prognosis of patients in our hospital.Results:Compared with the TCGA database,our hospital has more M5b subtypes(78.0%vs 36.4%,P=0.000).The median bone marrow blast cell ratio is lower(69%vs 83%,P=0.006).In our hospital,NPM1 mutations are fewer mutations(25.4%vs 54.5%,P=0.013),and fewer DNMT3A mutations(8.5%vs 50%,P=0.000).There was no statistically significant difference in OS between patients with chemotherapy alone in our hospital and TCGA database(P=0.379).Univariate analysis showed that age,white blood cell count,degree of initial remission,FLT3-ITD mutation,NPM1 mutation but not FLT3-ITD mutation,and prognostic risk stratification were significantly related to prognosis(P<0.05).Multivariate analysis showed age,white blood cell count,degree of initial remission and prognostic risk stratification were independent risk factors affecting prognosis(P<0.05).Conclusion:The prognosis of AML-M5 is related to age,white blood cell count,degree of initial remission and prognostic risk stratification.