The Relationship Between Of Iimmunophenotype And Clinical Charicteristics And Prognosis Of Childhood Acute Myeloid Leukemia

Objective:Acute myeloid leukemia(AML)is a rare malignancy which has a very low incidence and fewer cases in one sigle institution.Therefore,many observations about the influence of immunophotype on clinical charisteristics and prognosis varied among different studies.In this thesis we enrolled 183 cases with AML during 6 years in my center to figure out the relationship between immunophenotype and the biological characteristics of children with different AML and evaluat the influence of AML immunophenotypes on chemotherapy response and prognosis.Methods:A total of 183 newly diagnosed AML children(excluding PML-RARA positive M3 children and mixed cell leukemia children)were selected from the children's hospital affiliated to Soochow University on July 2012 to May 2018.MICM typing was used for the diagnosis of AML.All the patients were treated by stratified treatment according to the risk stratification criteria.Flow cytometry was performed to analyze the immunophenotypes.The immunophenotypes were divided into positive group and negative group according to their expression in blast cells.The positive group was the experimental group,and the negative group was the control group.Immunophenotypic markers were divided into four categories:1.Myeloid markers:immune logo MPO(positive/negative:163/20),CD 13(positive/negative:68/1 1 5),CD33(positive/negative:140/43)CD11b(positive/negative:86/42),CD64(positive/negative:83/47),CD36(positive/negative:43/43),CD 14(positive/negative:23/160),CD 15(positive/negative:111/60)?CD117(positive/negative:116/67);2.Megakaryocyte marker CD41(positive/negative:9/174);3.Lymphoblastic markers:CD19(positive/negative:38/145),CD7(positive/negative:26/157),CD2(positive/negative:14/169);4.Stem cell markers:CD34(positive/negative:142/41),HLA-DR(positive/negative:155/28),CD 123(positive/negative:124/39).The complete remission rate of 2 induction chemotherapy for each immunophenotype was compared by chi-square test.Kaplan-meier method was used for survival analysis of immunophenotype,and log-rank test was used for comparison between survival.COX proportional risk model was used to analyze whether each immunophenotype was an independent prognostic factor.Binary Logistic regression analysis of immunopathological phenotype related risk factors.p<0.05 was regarded as statistically significant.Results:1.Univariate analysis showed that the CR for the first and second induction chemotherapy was 90.1%,and 94.4%,respectively,in the CD 15 expression group which was higher than that in the negative group(9.9%,5.6%),(p=0.023,p=0.013).2.Univariate analysis showed that OS in the CD11b positive group was significantly worse than that in the negative group(p=0.04),suggesting that it was a prognostic factor.Both the CD117 positive group and the conjunctivian-antigen positive group had significantly better OS than the negative groups(P=0.03),suggesting a favorable prognostic factor.However,multivariate COX proportional risk analysis showed that each immunophenotype had no independent prognostic value.3.Binary Logistic regression analysis indicated the following results:i.That patients with positive MLL,HOX11 or BCR/ABL fusion genes were more likely to express CD15.ii.The CD11b expression was more likely expressed in the children with high leukocyte at initial stage and high risk.iii.The CD11b expression was more likely in the children with AML who didn't have CEBP double mutation,c-kit,FLT3-ITD or ASXL1 mutation.iv.The possibility of CD117 expression with higher level was in older patients and lower level in children with AML combined with complicated karyotype.v.There were no independent factors affecting CD 19 expression.vi.The possibility of Ly expression was not common in AML with MLL,HOX11 or BCR/ABL fusion gene positive.Conclusions:1.The efficacy of induced remission in AML children with CD 15 positive was higher than that in AML children with CD 15 negative?2.The immunophenotype of children with AML has a certain influence on the prognosis,but it cannot be used solely for the assessment of pretreatment risk,which requires a multi-parameter joint assessment.