Genetics Stratifications Effect On The Prognosis Of Acute Myeloid Leukemia (non-M3)

Objective:To explore the ELN prognostic stratification standard s effect on complete remission rate, early relapse rate and one year overall survival rate of acute myeloid leukemia (non-M3), the aim is to select appropriate treatment plans for actue myloid leukemia refering to ELN prognostic stratification standard.Methods:Collected 36 cases of primary AML (non-M3) from the first affiliated hospital of kunming medical university hematology department from January 2011 to April 2016, gathering basic perfect cytogenetics and molecular genetics data of 23 AMLpatients, without cytogenetics and molecular genetics of 13 patients.Treatment: induction treatment consist of 1-2 cycles, the treatment schemes are IA, DA, MA,the CAG+Decitabine; consolidation treatment:insist on 1-2 cycles the original treatment plan;Intensive treatment:middle and high dose cytarabine (1-4 g/dx3d) 2-4 cycles;Maintenance treatment options:MA, EA, the CAG+Decitabine, IA, Decitabine+cytarabine+arsenic trioxide. useing the diagnosis and curative effect standard evaluation of Zhang Zhinan to evaluate the therapeutic reaction.Then I divide all the patients into four groups according to the ELN prognostic stratification standard, favorable, intermediate-I,intermediate-II, and adverse,then compare the induction remission rate. early relapse rate.1-year overall survival rate.gender.age. White blood cell count and performance status score with each other,to explore the relationship between therapeutic effect and prognosis of stratification,the same to the various factors.Results:1. There are 23 AML(non-M3) patients collected, including 13 patients who are normal karyotype and negative gene mutations,57% of the total. favorable group contain 3 cases:0 male,3 female; intermediate-I group contain 13 cases:2 male,11 female; intermediate-II group contain 3 cases:2 male and 1 female; adverse group contain 4 cases:1 male,3 female.2. According to the ELN genetics Prognostic stratification,CR rates of the four groups are as follows:CR rate of favorable group was 100%; CR rate of intermediate-I group was 85%; CR rate of intermediate-II group was 67%; CR rate of adverse group was 75%.Statistical analysis of two contrast (P> 0.05).3. Early relapse rates of the four groups are as follows:Early relapse rate of favorable group was 0%; Early relapse rate of intermediate-I group was 20%; Early relapse rate of intermediate-II group was 0%; Early relapse rate of adverse group was 33%.Statistical analysis of two contrast (P> 0.05).4. one year overall survival rates of the four groups are as follows:one year overall survival rate of favorable group was 100%; one year overall survival rate of intermediate-I group was 63%; one year overall survival rate of intermediate-II group was 50%; one year overall survival rate of adverse group was 50%.Statistical analysis of two contrast (P> 0.05).5. gender is as follows:the most patients of favorable group/intermediate-I group/adverse group is female; the most patients of intermediate-II group is male. Statistical analysis of two contrast (P> 0.05).6. Age is as follows:the average age of favorable group is 17; the average age of intermediate-I group is 50 years old; the average age of intermediate-II group is 53 years old; the average age of adverse group is 34 years old. Statistical results show that the patients of favorable group are younger than intermediate-I group median age(P=0.004< 0.05), the patients of favorable group are younger than intermediate-II group median age(P= 0.001< 0.05);The remaining two contrast(P> 0.05).7. White blood cell count is as follows:the average white blood cell count of favorable group is 39.85×109/L; the average white blood cell count of intermediate-Ⅰ group is 33.36×109/L; the average white blood cell count of intermediate-Ⅱ group is 73.05×109/L; the average white blood cell count of intermediate-Ⅱ group is 21.66×109/L; Statistical analysis of two contrast (P > 0.05).8. performance status score is as follows:the average score of favorable group is 1; intermediate-I group is 0.85; intermediate-II group is 2; intermediate-II group is 1.25; Statistical results show that intermediate-I group score is higher than intermediate-II group (P=0.038<0.05).9. The CR rate/early relapse rate/1-year overall survival rate between Genetics data set and without the genetic data are no statistically significant difference,(P> 0.05), genetics data set can represent all of the AML patients.Conclusions:1. ELN stratification Standardized System is related to the prognosis of acute myeloid leukemia (non-M3),which can be a guidance for the clinical treatment.2. Age, performance status score and cytogenetics, molecular genetics is one of the most important prognostic indicators of acute myeloid leukemia.3. The prognosis of Intermediate risk is in great difference,so we should detail the Intermediate risk group further.