The Analysis Of Prognostic Factors In Patients With Extramedullary Infiltration Of Myeloid Neoplasms With 33 Clinical Cases

Objective: To investigate the clinical characterization and prognostic factors of hematopoietic myeloid neoplasms with extramedullary infiltration.Materials and Methods: A total of 33 patients with extramedullary infiltration of myeloid neoplasm admitted to the Department of Hematology of the First Hospital of Lanzhou University from October 2007 to April 2019 were collected in the study.According to the 2016 revised WHO classification of myeloid neoplasms and acute leukemia,the 33 patients were divided into different groups according to the type of myeloid neoplasms and the type of pathology of extramedullary infiltration at the time of initial diagnosis.We retrospectively analyzed the impact of various clinical parameters on overall survival(OS)in patients with different groups.The Kaplan-Meier survival analysis was used to assess the OS in 33 patients and different groups.Cox proportional hazard regression analysis was further used to analyze multifactorial factors that may affect the prognosis.Clinical data analysis was performed using SPSS 23.0 statistical software.For all analyses,P<0.05 was statistically significant.Results:1.33 patients with myeloid neoplasms were classified as acute myeloid leukemia(AML)group(22 cases)and non-AML group(11 cases);According to the type of extramedullary histopathology,33 patients were divided into myeloid sarcoma(MS)group(15 cases)and non-MS group(18 cases).Among the 33 patients with extramedullary infiltration,18 were male and 15 were female,with a minimum age of 3 years,a maximum age of 82 years and a median age of 38 years.There were 22 cases of AML,7 cases of chronic myelogenous leukemia(CML),2 cases of chronic myelomonocytic leukemia(CMML)and 2 cases of myelodysplastic syndrome(MDS)at first diagnosis.Central nervous system(CNS)infiltration was the most common,with a total of 20 cases,followed by lymph node infiltration in 4 cases,skin infiltration in 4 cases,and infiltration in bone,pleura,breast,external auditory canal and multiple organs in 1 case respectively.2.There was no significant difference in age,sex,hemoglobin,karyotype,location of extramedullary infiltration,pathological type,survival time and treatment between AML group and non-AML group.There were significant differences between the two groups in peripheral blood leukocyte count(P<0.02),platelet count(P<0.01)and percentage of blasts in bone marrow(P<0.01).There were significant differences between the two groups in peripheral blood leukocyte count(P=0.03)and extramedullary infiltration site(P<0.01).3.The median overall survival time(OS)of 33 patients with extramedullary infiltration of myeloid neoplasm was 4.6 months,with a two-year survival rate of 9.0%.The median OS was 5 months(95%CI,2.6-6.5)in AML group and 3 months in nonAML group,and there was no significant difference in OS between AML group and non-AML group(P=0.189).The median OS of MS group was 4 months(95%CI,2.1-7.1),with a two-year overall survival rate of 6.0%.There was a statistically significant difference in the two-year survival rates between chemotherapy and non-chemotherapy patients(P<0.01),the median OS of non-MS group was 3 months and the total twoyear survival rate was 11%,and there was a significant difference in the two-year survival rate between the chemotherapy group and the non-chemotherapy group(P<0.01).There was no significant difference in OS between the MS group and the nonMS group(P=0.709).4.The multivariate prognostic analysis of Cox model showed that the independent prognostic factors of OS in patients with extramedullary infiltration of myeloid neoplasms were transfusion dependence,active chemotherapy and combination therapy.5.24 of 33 patients were examined for chromosome karyotype and 7 for gene mutation.Among them,19 were in the group with normal chromosome and good prognosis,5 were in the group with complex karyotype,3 were FLT3-ITD positive in the group with normal chromosome karyotype,1 was FLT3-TKD positive alone,1 was FLT3-ITD and DNMT3 A positive,1 was FLT3-ITD and DNM1 positive,1 was TET2 and DNMT3 A positive,and 1 was TLS/ERG positive.Among the abnormal karyotypes,KIT/D816 V was positive in 1 case,FLT3-ITD,KIT/D816 V were positive and WT1 was highly expressed in 1 case.Conclusion:1.MS patients accounted for 45.5% of the extramedullary infiltration of myeloid neoplasm,and AML was the most common,followed by CML-BP and the transition period of CMML.There was no significant difference in the OS of AML,CML and CMML patients with extramedullary infiltration.2.When extramedullary infiltration occurred in 33 patients with myeloid neoplasm,timely and effective chemotherapy can significantly improve the OS of patients compared with symptomatic support treatment.Chemotherapy combined with local radiotherapy or surgery can improve the local symptoms of patients.Compared with chemotherapy alone,there is no significant difference in survival rate between the two groups.3.Blood transfusion dependence,active chemotherapy and combination therapy are independent prognostic factors affecting the OS of 33 patients with extramedullary infiltration of myeloid neoplasm.The abnormal chromosome karyotype may be related to the prognosis of patients with extramedullary infiltration of myeloid neoplasm,but there is no significant difference in the sample size.