AML1/ETO阳性急性髓系白血病患者FLT3基因高表达及其临床意义

本研究旨在探讨AML1/ ETO融合基因阳性的急性髓系白血病M2（acute myeloid leukemia with maturation,AML/M2）患者FLT3基因表达量与临床症状和预后的相关性及其意义.采用RQ-PCR法定量检测21例AML1/ETO阳性AML-M2患者初诊骨髓标本中FLT3基因的表达水平,并分析FLT3基因表达量的高低与临床特征、实验室其它检测结果及预后的关系.结果表明：患者FLT3基因表达水平（FLT3基因/内参基因）初诊时为1.65％-261.5％.据此将FLT3基因表达水平大于35％者归为高表达组（12例）,其表达水平低于35％者归为低表达组（9例）.高表达组患者初诊时白细胞计数＞ 10×109/L者8例（66.67％）,低表达组2例（22.22％）;伴有髓外浸润患者的比例在高表达组为25％,低表达组为0％,但由于例数较少,暂无统计学意义（P=0.0805;P=0.2286）.两组患者年龄以及骨髓原始细胞比例无明显差异（P =0.1369,P=0.6923）.FLT3基因高表达组和低表达组化疗完全缓解（CR）率为（66.67％ vs 88.89％）,其差异无统计学意义（P =0.3383）,而复发率（66.67％ vs 22.22％）及死亡率（50％ vs 22.22％）的差异虽无统计学意义（P =0.0805,P=0.3666）,但有很明显的差异趋势.结论：AML1/ETO阳性AML-M2患者FLT3基因表达量高提示患者预后不良,易复发,常规检测初诊AML1/ ETO阳性AML-M2患者骨髓中FLT3基因表达量对患者的危险度分层、预后评估以及个体化治疗方案的选择可能具有重要的指导意义.

FLT3 Gene Overexpression and Its Clinical Significance in Acute Myeloid Leukemia with AML1/ETO Fusion Gene Positive

This study was aimed to investigate the expression levels of FLT3 gene in AML-M2 patients carrying AML1/ETO fusion gene,and analyze its relation with clinical and laboratorial features and prognosis.RQ-PCR method was used to detect the expression level of FLT3 in bone marrow of 21 AML-M2 patients with AML1/ETO ＋.The correlation of the expression level of FLT3 with clinical features,other laboratorial examinations and disease prognosis were analyzed.The results showed that gene expression level of FLT3 （FLT3 gene/reference gene） in patients at initial diagnosis were 1.65%-261.5%.The expression level of FLT3 over 35% was defined as high expression group（12 cases）,while the expression level below 35% was defined as low expression group（9 cases）.The proportion of patients with extramedullary infiltration in high expression group was higher than that in low expression group （25% vs 0%,P =0.2286）.The proportion of patients at initial diagnosis with white blood cell count 〉 10 × 109/L in high expression group was higher than that in low expression group（66.67% vs 22.22%）,but there was no statistical significance（P =0.0805）.No significant difference was observed at the age （P =0.1369） and the rate of bone marrow blasts （P =0.6923） between the above mentioned two groups.The differences in complete remission rate （66.67% vs 88.89%,P =0.3383）,the relapse rate （66.67 % vs 22.22%,P =0.0805） and the mortality rate （50% vs 22.22%,P =0.3666） between the two group were not significant,but there was a clear trend that the low expression group has a higher CR rate and a lower relapse rate and mortality rate.It is concluded that FLT3 gene high expression in AML-M2 patients with AML1/ETO＋ have a higher rate of relapse and hence poor prognosis.Therefore,detection of FLT3 expression level in routine clinical practice is important for patient＇s risk stratification,prognostic evaluation and effective treatment selection.