伴EVI1高表达的中高危急性髓系白血病临床特点及早期治疗效果

发布时间：2019-07-05 18:25

【摘要】：目的:探讨EVI1基因阳性的急性髓系白血病(acute myeloid leukemia,AML)患者的临床生物学特点及其对早期化疗疗效的影响。方法:选择2015年3月至2016年7月在北京大学血液病研究所诊治的361例AML患者病例资料进行回顾性分析,其中33例AML患者EVI1基因阳性,分析比较其临床特征和生物学特征,并比较中危及高危伴EVI1+AML患者的临床与生物学特征及诱导缓解率,分析获得完全缓解(complete remission,CR)的影响因素。32例健康供者进行EVI1/ABL基因水平检测,确定EVI1表达的异常界值。结果:以EVI1/ABL基因定量表达≥8.0%作为EVI1的阳性表达。在361例初发AML中,EVI1+AML患者共33例(9.1%),其中男性16例,女性17例,中位年龄45(18~67)岁,中位随访期为6.6(0.7~13.2)个月。中危核型17例,包括正常核型9例,1例+8;高危核型14例,包括7例-7/7q-,4例t(v;11q23),3例inv(3)/t(3;3),2例未见分裂象。33例患者1个疗程完全缓解率为42.4%,总CR率为60.6%。按《美国国立综合癌症网络(National Comprehensive Cancer Network,NCCN)指南》预后分层,分为中危组16例,高危组17例,无低危组患者。中危组与高危组1个疗程CR率分别为68.8%和17.6%(P=0.005),总CR率分别为81.3%和41.2%(P=0.032),复发率为7.7%和14.3%。单因素分析,高危染色体核型对1个疗程CR率及总体CR率均有影响(P=0.004、0.029)。高危组患者病死率显著高于中危组(41.2%vs.6.3%,P=0.039),且总生存(overall survival,OS)显著低于中危组(P=0.012)。结论:EVI1基因在AML中常伴中、高危核型表达,对于AML患者来说可能不是独立的预后因素,伴-7/7q-、t(v;11q23)及inv(3)/t(3;3)等高危染色体核型的预后差,其1个疗程CR率及总CR率、长期生存率低,病死率高,应尽早行异基因造血干细胞移植。
[Abstract]:Objective: to investigate the clinical biological characteristics of EVI1 gene positive patients with acute myeloid leukemia (acute myeloid leukemia,AML) and its effect on early chemotherapy. Methods: the data of 361patients with AML diagnosed and treated in the Institute of Hematology, Peking University from March 2015 to July 2016 were analyzed retrospectively. among them, 33 patients with AML were positive for EVI1 gene. The clinical and biological characteristics and induced remission rate of patients with high risk and EVI1 AML were analyzed and compared, and the complete remission (complete remission, was obtained. The influencing factors of CR). The level of EVI1/ABL gene was detected in 32 healthy donors to determine the abnormal boundary value of EVI1 expression. Results: the quantitative expression of EVI1/ABL gene 鈮，

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