p16基因缺失在成人ph阴性急性B淋巴细胞白血病中的临床意义

目的 探讨 p16基因缺失对成人 Ph阴性急性 B淋巴细胞白血病（B-ALL）患者的临床特征及预后的影响。方法 回顾性分析210例初发成人ph阴性B-ALL患者的临床资料，根据初发时检测的p16基因状态分为p16基因缺失组 61例和无缺失组 149例。比较 p16基因缺失与无缺失组患者的临床、免疫表型、细胞遗传学、分子学特征及预后。结果 p16基因缺失组中伴 CD20表达者所占比例明显高于无缺失组（47.5% vs. 30.8%，χ2=5.238，P＜0.05），2组患者间其余免疫表型和细胞遗传学分布差异无统计学意义。p16基因缺失组造血干细胞移植率和完全缓解率与无缺失组差异均无统计学意义，复发率明显高于无缺失组（χ2=12.027，P＜0.05）。79例复发患者中，4例患者初发时未检测出 p16 基因缺失，而复发时检测出 p16 基因缺失。p16 基因缺失组患者的 OS 和 DFS 明显低于无缺失组（Logrank χ2分别为 16.715、21.237，均 P＜0.05）。p16基因缺失组中接受造血干细胞移植患者的 OS和 DFS均优于化疗患者（Log-rank χ2分别为25.316、20.637，均 P＜0.05）。p16基因缺失组CD20阳性患者OS和DFS均明显低于CD20阴性者（Log-rank χ2分别为 7.782、5.733，均 P＜0.05）。结论 p16基因缺失患者 CD20阳性表达率高且预后差，造血干细胞移植能够明显改善p16基因缺失患者的预后。

Clinical significance of p16 gene deletion in adult Philadelphia-negative B- lineage acute lymphoblastic leukemia

Objective To investigate the prevalence, feature and specific prognostic relevance of p16 gene deletion inChinese adult patients with Philadelphia-negative B- lineage acute lymphoblastic leukemia (B-ALL). Methods Clinical data of 210 newly diagnosed B-ALL patients were analyzed retrospectively. According to the p16 gene status at diagnosis, 61 cases were divided into the p16 gene deletion group and 149 cases were divided into the p16 non-deletion group. The clinical data, immune phenotypes, cytogenetics, molecular characteristics and prognosis were compared between two groups of patients. Results The proportion of patients with p16 gene deletion accompanied with CD20-positive were significantly higher in p16 gene deletion group compared with those of p16 non-deletion patients (47.5% vs. 30.8%, χ2=5.238, P＜0.05).There were no significant differences in the other immunophenotypes and cytogenetics between the two groups (P＞0.05).There were no significant differences in the transplant rate and complete remission of hematopoietic stem cells between the two groups. The recurrence rate was significantly higher in the p16 gene deletion group than that of p16 non-deletion group(χ2=12.027，P＜0.05). Among the 79 patients with relapse, 4 patients were not detected p16 gene deficiency at the initial stage, while p16 gene deletion was detected at the time of relapse. There were lower overall survival (OS) and disease freesurvival (DFS) in the p16 gene deletion group than those of p16 non-deletion group (Log-rank χ2=16.715 and 21.237，P＜0.05). Among the patients of p16 gene deletion, the patients received allogenic hematopoietic stem cell transplantation (AlloHSCT) showed a better OS and DFS compared with those of patients with chemotherapy (Log-rank χ2=25.316 and χ2=20.637，P＜0.05). There were lower values of OS and DFS in patients with CD20-positive than those of patients with CD20-negative in p16 gene deletion group (Log-rank χ2=7.782 and χ2=5.733，P＜0.05). Conclusion There are higher rate of CD20-positive and poor prognosis in patients with p16 gene deletion. Hematopoietic stem cell transplantation can significantly improve the prognosis of patients with p16 gene deletion.