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| 联合CD19和KITD816进一步优化t（8；21）急性髓系白血病预后分层 | |
| 引用本文： | 王彪,林榕榕,杨斌,李海乾,邢姗姗,张修文,谢晓宝,严峰. 联合CD19和KITD816进一步优化t（8；21）急性髓系白血病预后分层[J]. 中华临床医师杂志(电子版), 2019, 13(8): 589-595. DOI: 10.3877/cma.j.issn.1674-0785.2019.08.006 |
| 作者姓名： | 王彪 林榕榕 杨斌 李海乾 邢姗姗 张修文 谢晓宝 严峰 |
| 作者单位： | 1. 213000 江苏常州，常州市第一人民医院血液科2. 310013 浙江杭州，浙江医院血液科3. 213000，江苏常州，南京医科大学附属常州二院血液科 |
| 摘 要： | 目的分析当前治疗模式下的t（8；21）急性髓系白血病（AML）患者的缓解和预后异质性，为进一步个体化治疗提供依据。 方法收集2014年10月至2018年9月常州市第一人民医院107例标准方案诱导的成人初治t（8；21）AML患者，综合传统MICM和二代测序（NGS）基因突变特征，应用多因素Logistic和Cox回归分析，评价完全缓解（CR）率、累积复发率、无事件生存（EFS）和总生存（OS）的影响因素。 结果诱导1个疗程后，CR率为79.0%（83/105），早期死亡率为1.9%（2/107）。多因素分析显示，KIT-D816突变阳性是不良影响CR率［HR=3.29（1.18~9.24），P=0.023］、EFS［HR=3.53（1.82~6.84），P=0.000］和OS［HR=5.45（1.77~16.84），P=0.003］的唯一独立因素。CD19表达阴性是唯一独立预测累积复发率增加的不利因素［HR=0.32（0.10~1.00），P=0.050］。而KIT突变、KIT-N822和复杂核型对任何终点均不构成独立意义。 结论建议将特定的KIT-D816突变而非KIT突变纳入t（8；21）AML危险分层体系；CD19表达阴性的t（8；21）AML患者复发风险增加，需密切监测。 |
| 关 键 词： | t（8 21） 急性髓系白血病 CD19 二代测序 KIT 预后 |
| 收稿时间： | 2019-02-16 |
CD19 combined with KITD816 for optimization of prognostic stratification of t(8;21) acute myeloid leukemia |
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| Biao Wang,Rongrong Lin,Bin Yang,Haiqian Li,Shanshan Xing,Xiuwen Zhang,Xiaobao Xie,Feng Yan. CD19 combined with KITD816 for optimization of prognostic stratification of t(8;21) acute myeloid leukemia[J]. Chinese Journal of Clinicians(Electronic Version), 2019, 13(8): 589-595. DOI: 10.3877/cma.j.issn.1674-0785.2019.08.006 | |
| Authors: | Biao Wang Rongrong Lin Bin Yang Haiqian Li Shanshan Xing Xiuwen Zhang Xiaobao Xie Feng Yan |
| Affiliation: | 1. Department of Hematology, Changzhou First People's Hospital, Changzhou 213000, China 2. Department of Hematology, Zhejiang Hospital, Hangzhou 310013, China 3. Department of Hematology, Nanjing Medical University Affiliated Changzhou Second Hospital, Changzhou 213000, China |
| Abstract: | ObjectiveTo analyze the heterogeneity of remission and prognosis of patients with t(8; 21) acute myeloid leukemia (AML) under current treatment modalities, and to provide a basis for further risk-adapted treatment. MethodsA total of 107 adult patients with primary t(8; 21) AML treated with the standard 3+ 7 regimen at Changzhou First People's Hospital from October 2014 to September 2018 were collected. The complete remission (CR) rate, cumulative incidence of relapse, event-free survival (EFS), and overall survival (OS) were evaluated by combining the characteristics of traditional Morphology, Immunology, Cytogenetics, and Molecular biology (MICM) and genetic mutations based on next-generation sequencing (NGS) using multivariate Logistic and Cox regression analyses. ResultsAfter a single induction course, the CR rate was 79.0% (83/105) and the early mortality rate was 1.9% (2/107). Multivariate analysis showed that positive KIT-D816mut was the only independent factor adversely affecting the CR rate (hazard ratio [HR]=3.29 [1.18-9.24], P=0.023), EFS (HR=3.53 [1.82-6.84], P=0.000), and OS (HR=5.45 [1.77-16.84], P=0.003). Negative CD19 expression was the only independent predictor of increased cumulative incidence of relapse (HR=0.32 [0.10-1.00], P=0.050). KITmut, KIT-N822, and complex karyotype were not independent risk factors for all endpoints. ConclusionsIt is suggested that the specific KIT-D816mut, rather than general KITmut, should be included in the risk stratification system of t(8; 21) AML. Patients with negative CD19 have an increased risk of relapse, which requires close monitoring. |
| Keywords: | t(8 21) Acute myeloid leukemia CD19 Next-generation sequencing KIT Prognosis |
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