FLT3-ITD阳性与阴性急性髓细胞白血病的实验室特征及预后比较

摘要

目的 比较伴FLT3基因突变(FLT3-ITD+)与不伴FLT3基因突变(FLT3-ITD-)的急性髓细胞白血病(AML)患者的实验室特征、疗效以及预后.方法 2010年10月-2012年10月收治的初诊AML患者93例,年龄10～66岁,包括21例FLT3-ITD+ AML(22.6％)和72例FLT3-ITD AML(77.4％,对照组)列入分析.比较两组患者的临床表现,HOX11、EVI、ETO、MLL、NPM1基因表达情况,细胞学抗原(CD34/CD38、淋巴抗原、CD7和CD4)表达情况,细胞遗传学表现(正常核型、复杂核型),2年无事件生存(EFS)和2年总生存(OS)情况.结果 FLT3-ITD+AML初诊时合并外周血白细胞增高(＞100×109/L)及出血者多于FLT3-ITD-组(P＜0.01,P=0.004),但两组在年龄、免疫表型及染色体异常等方面无明显差异.FLT3-ITD+AML完全缓解(CR)率28.57％,显著低于FLT3-ITD-AML的55.56％(P=0.03).FLT3-ITD+AML 2年无事件生存率为29.2％,低于FLT3-ITD-AML组(37.7％,P=0.04).FLT3-ITD+AML联合表达NPM1者占33.33％,明显高于FLT3-ITD-AML组(1.39％,P=0.001).FLT3-ITD+AML中表达NPM1的患者均未达完全缓解.结论 FLT3-ITD+AML易合并白细胞增高,完全缓解率低,无事件存活率低,预后差.%Objective To compare the clinical and laboratory characteristics,therapeutic efficacy and prognosis of acute myelogenous leukemia (AML) with or without FLT3-ITD gene mutation.Methods The clinical data of 93 AML patients,aged from 10 to 66 years,were retrospectively analyzed.Among them,21 patients were FLT3-ITD gene (FLT3-ITD+ AML group) positive,and 72 patients were negative for FLT3-ITD gene (FLT3-ITD-AML group).The patients' chromosomes were examined,and mutation of FLT3-ITD and NPM1 gene and the expressions of HOX11,ETO,EVI and NPM1 gene were analyzed,along with the 2-year event-free survival and 2-year overall survival were learned.Results At primary diagnosis,the proportion of patients with WBC＞ 100 × 109/L,and bleeding rate was significantly higher in FLT3-ITD+ AML group than that in FLT3-ITD-AML group (P=0.04; P=0.01),but no statistical difference was found in age,immunophenotype and chromosomal abnormality (P＞0.05).Thecomplete remission (CR) rate was 28.57％ in FLT3-ITD+ AML group,and it was obviously lower than that in FLT3-ITD-AML group (55.56％,P=0.013).The 2-year event-free survival was 29.2％ in FLT3-ITD+ AML group,and it was significantly lower than that in FLT3-ITD AML group (37.7％; P=0.04).Meanwhile,33.3％ of the patients in FLT3-ITD-AML group were also positive for NPM1 gene expression,and all of them did not get complete remission.However,only 1.39％ of the patients expressed NPM1 gene in FLT3-ITD-AML group,but 50％ of them got complete remission (P=0.022).Conclusion Patients with FLT3-ITD+AML were easily associated with high WBC counts,bleeding,lower CR rate,poor event-free survival,and poor prognosis.