联合CD19和KITD816进一步优化t（8；21）急性髓系白血病预后分层

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。

CD19 combined with KITD816 for optimization of prognostic stratification of t(8;21) acute myeloid leukemia

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.