DNMT3A与TET2双突变对急性髓系白血病患者预后的影响

Impact of DNMT3A and TET2 dual mutations on the prognosis of patients with acute myeloid leukemia

目的 探讨DNA甲基转移酶3A(DNMT3A)与甲基胞嘧啶双加氧酶-2(TET2)双突变对急性髓系白血病(AML)患者预后的影响。方法 回顾性选取2021年1月至2023年12月在南京江北医院治疗的DNMT3A与TET2双突变AML患者86例设为DNMT3A与TET2双突变组,同时选取DNMT3A单突变AML患者50例、TET2单突变AML患者80例作为对照,分别设为DNMT3A单突变组、TET2单突变组。比较各突变患者临床一般资料、红细胞计数(WBC)、血红蛋白、血小板计数(PLT)、初次诱导疗效及无进展生存时间差异。结果 DNMT3A与TET2双突变组患者年龄<60岁比例为93.02%,高于TET2单突变组(70.00%)、DNMT3A单突变组患者(62.00%),差异有统计学意义(P<0.05);各突变组患者WBC、血红蛋白及PLT比较,差异无统计学意义(P>0.05)。DNMT3A与TET2双突变组患者初次诱导完全缓解率为31.40%,明显低于TET2单突变组患者(71.25%),差异有统计学意义(P<0.05),与DNMT3A单突变组患者比较,差异无统计学意义(P<0.05);DNMT3A与TET2双突变组患者中位无进展生存时间为11个月(95%CI:10.48~11.52),明显少于TET2单突变组患者的22个月(95%CI:20.99~23.01),差异有统计学意义(P<0.05),与DNMT3A单突变组患者的12月(95%CI:10.70~13.30)比较,差异无统计学意义(P>0.05)。结论 相比较TET2单突变患者,DNMT3A与TET2双突变AML患者初次诱导疗效及预后较差。

Objective To explore the impact of dual mutations in DNA methyltransferase 3A(DNMT3A)and ten-eleven translocation-2(TET2)on the prognosis of patients with acute myeloid leukemia(AML).Methods A total of 86 patients with DNMT3A and TET2 double mutation AML who were treated in Nanjing Jiangbei Hospital from January 2021 to December 2023 were selected as the DNMT3A and TET2 group,while 50 patients with DNMT3A single mutation AML and 80 patients with TET2 single mutation AML were selected as the DNMT3A group and the TET2 group.The differences in clinical general information,red blood cell(WBC),hemoglobin,platelets(PLT),initial induction efficacy,and progression free survival time among patients with various mutations were compared.Results The proportion of patients with double mutations in DNMT3A and TET2 group who were under 60 years old was 93.02%,which was higher than that of patients with single mutations in TET2 group(70.00%)and DNMT3A group(62.00%),the difference was statistically significant(P<0.05).There was no statistically significant difference in WBC,hemoglobin,and PLT among the mutated patients(P>0.05).The initial induction CR rate of DNMT3A and TET2 dual mutation group patients was 31.40%,which was significantly lower than that of TET2 single mutation group patients(71.25%),the difference was statistically significant(P<0.05),and there was no statistically significant difference compared to DNMT3A single mutation group patients(P>0.05).The median progression free survival time of DNMT3A and TET2 dual mutation group patients was 11 months(95%CI:10.48-11.52),which was significantly lower than the 22 months(95%CI:0.99-23.01)of TET2 single mutation group patients,the difference was statistically significant(P<0.05),and there was no statistically significant difference compared to the 12 months(95%CI:10.70-13.30)of DNMT3A single mutation group patients(P>0.05).Conclusion Compared to TET2 single mutation patients,DNMT3A and TET2 double mutation AML patients have poorer initial induction efficacy and prognosis.