In this study,we compared the efficacy of mitoxantrone in combination with intermediate-dose cytarabine（HAM） with that of high-dose cytarabine alone（Hi DAC） as consolidation regimens in non-acute promyelocytic leu...In this study,we compared the efficacy of mitoxantrone in combination with intermediate-dose cytarabine（HAM） with that of high-dose cytarabine alone（Hi DAC） as consolidation regimens in non-acute promyelocytic leukemia（APL） acute myeloid leukemia patients with favorable and intermediate cytogenetics.A total of 62 patients from Shenzhen People＇s Hospital were enrolled in this study.All patients enrolled received standard induction chemotherapy and achieved the first complete remission（CR1）.In these patients,24 received Hi DAC and 38 received HAM as consolidation.The median relapse free survival（RFS） and overall survival（OS） were similar between these two consolidation regimens.Even in subgroup analysis according to risk stratification,the combination regimen conferred no benefit in longterm outcome in patients with favorable or intermediate cytogenetics.However,in patients receiving HAM regimen,the lowest neutrophil count was lower,neutropenic period longer,neutropenic fever rate higher,and more platelet transfusion support was required.HAM group also tended to have higher rate of sepsis than Hi DAC group.According to our results,we suggest that combination treatment with mitoxantrone and intermediate-dose cytarabine has limited value as compared to Hi DAC,even in young non-APL AML patients with favorable and intermediate cytogenetics.展开更多
Acute myeloid leukemia(AML) is a genetically heterogeneous myeloid malignancy that occurs more commonly in adults, and has an increasing incidence, most likely due to increasing age. Precise diagnostic classification ...Acute myeloid leukemia(AML) is a genetically heterogeneous myeloid malignancy that occurs more commonly in adults, and has an increasing incidence, most likely due to increasing age. Precise diagnostic classification of AML requires clinical and pathologic information, the latter including morphologic, immunophenotypic, cytogenetic and molecular genetic analysis. Risk stratification in AML requires cytogenetics evaluation as the most important predictor, with genetic mutations providing additional necessary information. AML with normal cytogenetics comprises about 40%-50% of all AML, and has been intensively investigated. The currently used 2008 World Health Organization classification of hematopoietic neoplasms has been proposed to be updated in2016, also to include an update on the classification of AML, due to the continuously increasing application of genomic techniques that have led to major advances in our knowledge of the pathogenesis of AML. The purpose of this review is to describe some of these recent major advances in the diagnostic classification and risk stratification of AML.展开更多
Mutations of fins-like tyrosine kinase 3 （FLT3） and nucleophosmin （NPM1） exon 12 genes are the most common abnormalities in adult acute myeloid leukemia （AML） with normal cytogenetics. To assess the prognostic i...Mutations of fins-like tyrosine kinase 3 （FLT3） and nucleophosmin （NPM1） exon 12 genes are the most common abnormalities in adult acute myeloid leukemia （AML） with normal cytogenetics. To assess the prognostic impact of the two gene mutations in Chinese AML patients, we used multiplex polymerase chain reaction （PCR） and capillary electrophoresis to screen 76 AML patients with normal cytogenetics for mutations in FLT3 internal tandem duplication （FLT3/ITD） and exon 12 of the NPM1 gene. FLT3/ITD mutation was detected in 15 （19.7%） of 76 subjects, and NPM1 mutation in 20 （26.3%） subjects. Seven （9.2%） cases were positive for both FLT3/ITD and NPM1 mutations Significantly more FLT3/ITD aberration was detected in subjects with French-American-British （FAB） M1 （42.8%）. NPM1 mutation was frequently detected in subjects with M5 （47.1%） and infrequently in subjects with M2 （11.1%）. FLT3 and NPM1 mutations were significantly associated with a higher white blood cell count in peripheral blood and a lower CD34 antigen expression, but not age, sex, or platelet count. Statistical analysis revealed that the FLT3/ITD- positive group had a lower complete remission （CR） rate （53.3% vs. 83.6%）. Survival analysis showed that the FLT3/ITD-positive/NPM1 mutation-negative group had worse overall survival （OS） and relapse-free survival （RFS）. The FLT3/ITD-positive/NPM1 mutation-positive group showed a trend towards favorable survival compared with the FLT3/ITD-positive/NPM1 mutation-negative group （P=0.069）. Our results indicate that the FLT3/ITD mutation might be a prognostic factor for an unfavorable outcome in Chinese AML subjects with normal cytogenetics, while NPM1 mutation may be a favorable prognostic factor for OS and RFS in the presence of FLT3/ITD.展开更多
To study the clinical and cytogenetic characteristics of four patients with myel odysplastic syndrome (MDS) and one with acute myeloid leukemia experiencing t(1; 7) Methods Five patients seen in our hospital from 19...To study the clinical and cytogenetic characteristics of four patients with myel odysplastic syndrome (MDS) and one with acute myeloid leukemia experiencing t(1; 7) Methods Five patients seen in our hospital from 1992 to 2001 were diagnosed as MDS and acute myelocytic leukemia (AML) according to the French American British (FAB) criteria Chromosomes were prepared using the direct method as well as 24 hou r unstimulated cultures of fresh heparinized bone marrow for each subject, while R banding was used to analyze karyotypes Dual color fluorescence in situ hy bridization (FISH) using SpectrumRed and SpectrumGreen directly labeled chromoso me 1 specific α satellite DNA probe (red) and chromosome 7 specific α sat ellite DNA probe (green) was performed for three cases Results Of the five patients, three had 1;7 translocation due to a long history of expos ure to benzene In three cases, dual color FISH resulted in three red signals and two green ones, in which one red signal adjoining one green signal in 27 6% , 84% and 18 5% metaphases, respectively Conclusions Exposure to benzene may be the cause for Chinese MDS and AML patients with t(1;7 ) translocation The result of dual color FISH convincingly confirmed that the centromere of the derivative chromosome 7p/1q resulting from 1;7 translocation was made up of centromeres from both chromosomes 1 and 7展开更多
Objective To investigate EVI1 expression and its associated clinical and cytogenetic characteristics in 447acute myeloid leukemia(AML)patients.Methods EVI1expressions were measured in 447 AML cases from Jan.2007 to Ap...Objective To investigate EVI1 expression and its associated clinical and cytogenetic characteristics in 447acute myeloid leukemia(AML)patients.Methods EVI1expressions were measured in 447 AML cases from Jan.2007 to Apr.2015 to couple with clinical。展开更多
Objective:To observe the clinical efficacy of Chinese drugs combined with chemotherapy in the treatment of acute myeloid leukemia(AML) and to investigate the prognostic relevance of the main parameters in AML treated ...Objective:To observe the clinical efficacy of Chinese drugs combined with chemotherapy in the treatment of acute myeloid leukemia(AML) and to investigate the prognostic relevance of the main parameters in AML treated with integrative medicine.Methods:Forty AML patients hospitalized at the authors hospital were treated with Chinese drugs and chemotherapy.The routine examination,immunophenotype and karyotype analyses were carried out.The clinical efficacy was observed and the prognostic factors were analyzed...展开更多
本研究旨在分析NPM1和FLT3-ITD突变与急性髓系白血病患者外周血白细胞数及骨髓原始细胞百分比的相关性。回顾分析我中心2009年1月至2011年12月份初治正常核型急性髓系白血病患者51例,其中男性22例,女性29例,中位年龄47岁(14-83岁)。采...本研究旨在分析NPM1和FLT3-ITD突变与急性髓系白血病患者外周血白细胞数及骨髓原始细胞百分比的相关性。回顾分析我中心2009年1月至2011年12月份初治正常核型急性髓系白血病患者51例,其中男性22例,女性29例,中位年龄47岁(14-83岁)。采用聚合酶链式反应检测NPM1及FLT3-ITD突变状态。结果表明,与无NPM1突变患者相比,突变者初诊时外周血白细胞数较多(30.7×109/L vs 8.6×109/L,P=0.002);FLT3-ITD突变患者较无突变患者具有更多的外周血白细胞数(42.38×109/L vs 11.45×109/L,P=0.033)及更高的骨髓原始细胞百分比(74.0%vs 60.25%,P=0.036)。外周血白细胞数及骨髓原始细胞百分比在NPM1、FLT3-ITD无突变组、单独NPM1突变组、单独FLT3-ITD突变组到NPM1、FLT3-ITD双突变组逐步升高(均P<0.05)。白细胞数大于12.55×109/L的患者NPM1突变率明显升高(P=0.002),大于37.85×109/L者FLT3-ITD突变率明显升高(P=0.033);原始细胞比例大于72.25%的FLT3-ITD突变率明显升高(P=0.008)。NPM1突变患者首疗程完全缓解率(CR)明显高于无突变者(78.13%vs 40.0%,χ2=4.651,P=0.031)。结论:NPM1及FLT3-ITD突变患者白细胞计数及原始细胞比例大,提示NPM1与FLT3-ITD突变均可能促进白血病细胞增殖,且二者可能具有协同效应。展开更多
基金supported by grants from the Basic Research Project of Shenzhen Science and Technology Program(No.JYCJ20150403101146307,No.JCYJ20150403101028195 and No.JCYJ20160422145031770)the National Natural Science Foundation of China(No.81600168)
文摘In this study,we compared the efficacy of mitoxantrone in combination with intermediate-dose cytarabine（HAM） with that of high-dose cytarabine alone（Hi DAC） as consolidation regimens in non-acute promyelocytic leukemia（APL） acute myeloid leukemia patients with favorable and intermediate cytogenetics.A total of 62 patients from Shenzhen People＇s Hospital were enrolled in this study.All patients enrolled received standard induction chemotherapy and achieved the first complete remission（CR1）.In these patients,24 received Hi DAC and 38 received HAM as consolidation.The median relapse free survival（RFS） and overall survival（OS） were similar between these two consolidation regimens.Even in subgroup analysis according to risk stratification,the combination regimen conferred no benefit in longterm outcome in patients with favorable or intermediate cytogenetics.However,in patients receiving HAM regimen,the lowest neutrophil count was lower,neutropenic period longer,neutropenic fever rate higher,and more platelet transfusion support was required.HAM group also tended to have higher rate of sepsis than Hi DAC group.According to our results,we suggest that combination treatment with mitoxantrone and intermediate-dose cytarabine has limited value as compared to Hi DAC,even in young non-APL AML patients with favorable and intermediate cytogenetics.
文摘Acute myeloid leukemia(AML) is a genetically heterogeneous myeloid malignancy that occurs more commonly in adults, and has an increasing incidence, most likely due to increasing age. Precise diagnostic classification of AML requires clinical and pathologic information, the latter including morphologic, immunophenotypic, cytogenetic and molecular genetic analysis. Risk stratification in AML requires cytogenetics evaluation as the most important predictor, with genetic mutations providing additional necessary information. AML with normal cytogenetics comprises about 40%-50% of all AML, and has been intensively investigated. The currently used 2008 World Health Organization classification of hematopoietic neoplasms has been proposed to be updated in2016, also to include an update on the classification of AML, due to the continuously increasing application of genomic techniques that have led to major advances in our knowledge of the pathogenesis of AML. The purpose of this review is to describe some of these recent major advances in the diagnostic classification and risk stratification of AML.
文摘Mutations of fins-like tyrosine kinase 3 （FLT3） and nucleophosmin （NPM1） exon 12 genes are the most common abnormalities in adult acute myeloid leukemia （AML） with normal cytogenetics. To assess the prognostic impact of the two gene mutations in Chinese AML patients, we used multiplex polymerase chain reaction （PCR） and capillary electrophoresis to screen 76 AML patients with normal cytogenetics for mutations in FLT3 internal tandem duplication （FLT3/ITD） and exon 12 of the NPM1 gene. FLT3/ITD mutation was detected in 15 （19.7%） of 76 subjects, and NPM1 mutation in 20 （26.3%） subjects. Seven （9.2%） cases were positive for both FLT3/ITD and NPM1 mutations Significantly more FLT3/ITD aberration was detected in subjects with French-American-British （FAB） M1 （42.8%）. NPM1 mutation was frequently detected in subjects with M5 （47.1%） and infrequently in subjects with M2 （11.1%）. FLT3 and NPM1 mutations were significantly associated with a higher white blood cell count in peripheral blood and a lower CD34 antigen expression, but not age, sex, or platelet count. Statistical analysis revealed that the FLT3/ITD- positive group had a lower complete remission （CR） rate （53.3% vs. 83.6%）. Survival analysis showed that the FLT3/ITD-positive/NPM1 mutation-negative group had worse overall survival （OS） and relapse-free survival （RFS）. The FLT3/ITD-positive/NPM1 mutation-positive group showed a trend towards favorable survival compared with the FLT3/ITD-positive/NPM1 mutation-negative group （P=0.069）. Our results indicate that the FLT3/ITD mutation might be a prognostic factor for an unfavorable outcome in Chinese AML subjects with normal cytogenetics, while NPM1 mutation may be a favorable prognostic factor for OS and RFS in the presence of FLT3/ITD.
文摘To study the clinical and cytogenetic characteristics of four patients with myel odysplastic syndrome (MDS) and one with acute myeloid leukemia experiencing t(1; 7) Methods Five patients seen in our hospital from 1992 to 2001 were diagnosed as MDS and acute myelocytic leukemia (AML) according to the French American British (FAB) criteria Chromosomes were prepared using the direct method as well as 24 hou r unstimulated cultures of fresh heparinized bone marrow for each subject, while R banding was used to analyze karyotypes Dual color fluorescence in situ hy bridization (FISH) using SpectrumRed and SpectrumGreen directly labeled chromoso me 1 specific α satellite DNA probe (red) and chromosome 7 specific α sat ellite DNA probe (green) was performed for three cases Results Of the five patients, three had 1;7 translocation due to a long history of expos ure to benzene In three cases, dual color FISH resulted in three red signals and two green ones, in which one red signal adjoining one green signal in 27 6% , 84% and 18 5% metaphases, respectively Conclusions Exposure to benzene may be the cause for Chinese MDS and AML patients with t(1;7 ) translocation The result of dual color FISH convincingly confirmed that the centromere of the derivative chromosome 7p/1q resulting from 1;7 translocation was made up of centromeres from both chromosomes 1 and 7
文摘Objective To investigate EVI1 expression and its associated clinical and cytogenetic characteristics in 447acute myeloid leukemia(AML)patients.Methods EVI1expressions were measured in 447 AML cases from Jan.2007 to Apr.2015 to couple with clinical。
文摘Objective:To observe the clinical efficacy of Chinese drugs combined with chemotherapy in the treatment of acute myeloid leukemia(AML) and to investigate the prognostic relevance of the main parameters in AML treated with integrative medicine.Methods:Forty AML patients hospitalized at the authors hospital were treated with Chinese drugs and chemotherapy.The routine examination,immunophenotype and karyotype analyses were carried out.The clinical efficacy was observed and the prognostic factors were analyzed...
文摘本研究旨在分析NPM1和FLT3-ITD突变与急性髓系白血病患者外周血白细胞数及骨髓原始细胞百分比的相关性。回顾分析我中心2009年1月至2011年12月份初治正常核型急性髓系白血病患者51例,其中男性22例,女性29例,中位年龄47岁(14-83岁)。采用聚合酶链式反应检测NPM1及FLT3-ITD突变状态。结果表明,与无NPM1突变患者相比,突变者初诊时外周血白细胞数较多(30.7×109/L vs 8.6×109/L,P=0.002);FLT3-ITD突变患者较无突变患者具有更多的外周血白细胞数(42.38×109/L vs 11.45×109/L,P=0.033)及更高的骨髓原始细胞百分比(74.0%vs 60.25%,P=0.036)。外周血白细胞数及骨髓原始细胞百分比在NPM1、FLT3-ITD无突变组、单独NPM1突变组、单独FLT3-ITD突变组到NPM1、FLT3-ITD双突变组逐步升高(均P<0.05)。白细胞数大于12.55×109/L的患者NPM1突变率明显升高(P=0.002),大于37.85×109/L者FLT3-ITD突变率明显升高(P=0.033);原始细胞比例大于72.25%的FLT3-ITD突变率明显升高(P=0.008)。NPM1突变患者首疗程完全缓解率(CR)明显高于无突变者(78.13%vs 40.0%,χ2=4.651,P=0.031)。结论:NPM1及FLT3-ITD突变患者白细胞计数及原始细胞比例大,提示NPM1与FLT3-ITD突变均可能促进白血病细胞增殖,且二者可能具有协同效应。
