Clinical Characteristics And Prognostic Factors Of Acute Myeloid Leukemia M2 Subtype

Objective:To investigate the clinical features of acute myeloid leukemia M2(AML-M2)and analyze its prognostic factors.Methods:The clinical data of 128 patients with AML-M2 admitted to our hospital from January 2013 to December 2017 were collected by hospital medical record inquiry system.The clinical features and prognostic factors were retrospectively analyzed.result:1.General clinical features: 128 patients with a median age of 43(13-70)years,63 males and 65 females.The peripheral blood leukocyte count and hemoglobin concentration in patients with t(8;21)were lower than those in patients without t(8;21),but the difference was not statistically significant;the platelet count was also lower than that of patients with t(8;21).The group was significantly lower and the difference was statistically significant(P=0.013).More than 90% expressed surface antigens such as CDl3,CD33,CD34 and CD117.The positive expression rates of CD19 and CD56 were 14.4% and 8.8%,respectively,which were more common in t(8;21)AML patients(30.8% vs 2.6%,P =0.000;19.2% vs 1.3%,P = 0.001).There were 71 patients with normal karyotype and 52 patients with t(8;21),including 25 patients with sole t(8;21)and 27 with additional chromosomal abnormalities,mainly sex chromosome deletion(-X/-Y).Molecular examination showed that the incidence of FLT3-ITD mutation was 11.6%,the incidence of c-KIT mutation was 10.4%,and it was more common in t(8;21)patients.NPM1 and CEBPA mutations accounted for15.1% and 20.9%,respectively.Normal patient.2.Induction therapy relief and influencing factors: After the first course of induction therapy,80 patients(62.5%)achieved CR,the cumulative CR rate of 2courses was 86.7%.According to genetic characteristics,the CR rates of normalkaryotype,sole t(8;21),and additional chromosomal abnormalities were 61.9%,68.0%,and 55.6%,respectively.Age,gender,white blood cell count,and primordial cell ratio had no significant effect on the CR rate of the two groups.Both groups of patients showed that the IA regimen was superior to the DA regimen,but the difference was not statistically significant.In patients with t(8;21)AML,the CR rate of CD19+ was higher than that of CD19-(87.5% vs 50.0%,P=0.010).3.Univariate analysis showed that patients with additional chromosomal abnormalities had worse OS and PFS than patients with sole t(8;21).Age,gender,white blood cell count,CD19 and CD56,and c-KIT had no significant effect on prognosis.Patients with high dose cytarabine ≥ 3 times had advantages in OS and PFS(P<0.05).Multivariate analysis showed that t(8;21)alone was superior to additional chromosomal abnormalities on OS,but the difference between the two was not obvious on PFS.The patients with high doses of cytarabine ≥3 times were on OS and PFS.All patients were better than those with high doses of cytarabine <3times(P<0.05).in conclusion:1.The clinical features of AML-M2 are different.Different genetic changes have differences in peripheral blood,cell surface markers and molecular changes.The platelet count of patients with t(8;21)is low;CD19,CD56 cell surface markers,cKIT mutations are common in the t(8;21)patient group.2.The first induction remission rate was 62.5%.Age,white blood cell count,primordial cell ratio and cytogenetic abnormalities had no significant effect on CR rate.In patients with t(8;21)AML,the CR rate of CD19+ was higher than that of CD19-.3.With additional chromosomal abnormalities is a poor prognosis factor,medium and high doses of cytarabine 3 courses and above can improve the prognosis of patients.