动态监测AML1-ETO转录本水平在儿童急性髓系白血病中的预后价值

发布时间：2018-02-06 06:02

本文关键词： 急性髓系白血病 AML1-ETO融合基因微小残留病儿童预后　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的探讨动态监测AML1-ETO转录本水平在儿童t(8;21)急性髓系白血病(AML)预后评估中的价值。方法以2010年1月至2016年4月就诊于郑州大学人民医院的55例儿童t(8;21)AML患者为研究对象,应用实时定量PCR(RQ-PCR)技术动态监测患者的AML1-ETO转录本水平,分析其变化与疾病预后的关系。结果初诊时患者骨髓细胞中的AML1-ETO转录本水平与复发和预后无关。1个疗程诱导缓解治疗后,骨髓细胞中AML1-ETO转录本水平比诊断时下降大于2个对数级(a2 Log)者,与a2 Log者相比,5年累积复发率(CIR)分别为(24.3±8.4)%和(52.6±9.7)%(P=0.003);5年无复发生存(RFS)率分别为(71.6±12.7)%和(48.1±13.2)%(P=0.016);5年总生存(OS)率分别为(76.9±12.5)%和(48.9±14.7)%(P=0.012),差异均具有统计学意义;多因素Cox回归显示,1疗程诱导缓解后的AML1-ETO转录本下降是否大于2个对数级,是影响RFS、OS的独立预后因素(P0.05)。巩固治疗及治疗结束随访期间,连续动态监测AML1-ETO转录本水平变化,患者从分子学复发至血液学复发的中位时间为4个月。对2例分子学复发后的患者,及时采取异基因造血干细胞移植(allo-HSCT)治疗后,未发生血液学复发。结论通过RQ-PCR技术,连续动态监测儿童t(8;21)AML患者的AML1-ETO转录本水平,可以将儿童t(8;21)AML细分为相对低危组和相对高危组,早期识别出复发风险高的患者,为实现儿童t(8;21)AML的精准分层和风险-适应治疗提供科学依据。
[Abstract]:Objective to investigate the dynamic monitoring of AML1-ETO transcripts in children. 21) the prognostic value of acute myeloid leukemia (AML). Methods 55 cases of children with acute myeloid leukemia from January 2010 to April 2016 were treated at Renmin Hospital of Zhengzhou University. The AML1-ETO transcripts of 21AML patients were dynamically monitored by real-time quantitative PCRQ-PCRR technique. Results the level of AML1-ETO transcripts in bone marrow cells was not related to recurrence and prognosis. The levels of AML1-ETO transcripts in bone marrow cells decreased more than two logarithmic levels of A2Logs compared with those of A2 Log patients. The 5-year cumulative recurrence rate (CIRR) was 24.3 卤8.4% and 52.6 卤9.7%, respectively. The RFS rates of 5-year recurrence free survival were 71.6 卤12.7% and 48.1 卤13.2respectively. The total survival rate in 5 years was 76.9 卤12.5% and 48.9 卤14.7%, respectively. The difference was statistically significant. Multivariate Cox regression analysis showed whether the decrease of AML1-ETO transcripts was greater than two logarithmic levels after remission induced by one course of treatment, which was related to RFS. The independent prognostic factor of OS was P0.05.The changes of AML1-ETO transcripts were continuously monitored during the follow-up period of consolidation therapy and treatment. The median time from molecular recurrence to hematological recurrence was 4 months. After allogeneic hematopoietic stem cell transplantation (allo-HSCT), two patients were treated with allo-HSCT. There was no hematological recurrence. Conclusion the RQ-PCR technique was used to continuously monitor t0 8 in children. The AML1-ETO transcripts of 21 AML patients can be transformed into t0 8 in children; 21 AML was subdivided into relatively low risk group and relatively high risk group. Accurate stratification and risk-adaptation therapy of 21 AML provide scientific basis.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R733.71

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