Analysis Of Clinical Risk Factors For Transformation From Myelodysplastic Syndrome To Acute Myeloid Leukemia

ObjectiveTo summarize and analyze the general clinical features of 258 patients with myelodysplastic syndrome(MDS),To compare the clinical characteristics of MDS untransformed group and MDS transformed into acute myeloid leukemia(AML)group,to study the correlation between the indicators of clinical laboratory examination and the conversion of MDS to AML,and to explore the clinical risk factors of MDS transforming to AML.At the same time,it also provides important clinical data for completing the high risk factors of MDS.MethodsA total of 258 adult MDS patients admitted to the Department of Hematology of the first affiliated Hospital of Zhengzhou University from June 1,2016 to September 30,2019 were systematically reviewed and followed up by querying the detailed clinical characteristics of registered cases.258 patients were divided into two groups:MDS non-conversion group and MDS conversion group.The differences between the two groups were compared by χ2 test or Fisher exact probability test.Kaplan-Meier method was used for survival analysis,Kaplan-Meier test was used for univariate analysis of MDS to AML for the indicators with statistical differences between the two groups,and COX regression model was used for multivariate analysis to explore the risk factors for the conversion of MDS to AML.Result1.The data of 258 patients were divided into MDS non-conversion group and MDS conversion group,including MDS non-conversion group(n=218)and MDS conversion group(n=40).Among the 258 patients,40 cases were converted into AML,MDS into AML,and the conversion rate was about 15.50%.In the MDS conversion group,35 cases were converted from MDS to AML-M2(87.50%),2 cases were converted from MDS to AML-M4(5.00%),and 3 cases were converted from MDS to AML-M5(7.50%).2.In the analysis of clinical factors for the conversion of MDS to AML,the percentage of absolute neutrophils exceeded 0.8 in MDS transformed group was higher than that in MDS untransformed group(P<0.05).The proportion of serum lactate dehydrogenase exceeded 245U/L in MDS transformed group was higher than that in MDS untransformed group.(P<0.05).The proportion of peripheral blood primordial cells greater than or equal to 1%in MDS transformation group was higher than that in MDS untransformed group(P<0.05).The proportion of bone marrow blast cells greater than or equal to 5%in MDS transformation group was higher than that in MDS untransformed group(P<0.05).The proportion of peripheral blood cytopenia 3 lines in MDS transformation group was lower than that in MDS untransformed group(P<0.05).The positive expression rate of CD7,CD38,CD71,CD117,CD123,HLA-DR and cMPO,SRSF2 gene mutation rate,TET2 gene mutation rate,DNMT3A gene mutation rate and FLT3 gene mutation rate in MDS transformed group were significantly higher than those in MDS untransformed group(P<0.05).The positive expression rate of CD7,CD38,CD71,CD117,CD123,HLA-DR and cMPO in MDS transformed group was significantly higher than that in MDS untransformed group.There was no significant difference in age,sex,hemoglobin,platelet count,reticulocyte absolute count,serum ferritin,morbid hematopoiesis coefficient,chromosome karyotype number and chromosome karyotype quality between the two groups(P>0.05).There was no significant difference in the positive expression rates of CD11b,CD34 and CD56 between the two groups.There was no significant difference in gene mutation rates of U2AF1,ASXL1,SF3B1,RUNX1,TP53 and NRAS between the two groups.3.Survival analysis was performed by Kaplan-Meier method.The median survival time(MST)of MDS untransformed group and MDS transformed group were 16.00(0.53-51.00)months and 13.84(2.40-40.00)months,respectively.Compared with the survival curve of the two groups,the survival time of the MDS conversion group was shorter than that of the MDS non-transformation group(P<0.05),and the difference was statistically significant.4.Univariate analysis using Kaplan-Meier test.Serum lactate dehydrogenase exceeded 245U/L,peripheral blood primordial cells greater than or equal to 1%,bone marrow blast cells greater than or equal to 5%,immunophenotypic CD7 positive expression,immunophenotypic CD38 positive expression,immunopheno typic CD71 positive expression,immunophenotypic CD117 positive expression,immunophenotypic CD 123 positive expression,immunophenotypic HLA-DR positive expression,immunophenotypic cMPO positive expression,SRSF2 gene mutation,TET2 gene mutation,DNMT3A gene mutation,There were statistical differences in FLT3 gene mutations.All the above factors were related to the transformation of MDS into AML.However,there was no significant difference in absolute neutrophil and peripheral blood cytopenia coefficient in univariate analysis,which were not related factors affecting the transformation of MDS to AML(P>0.05).5.Multivariate analysis of COX regression model showed that bone marrow primordial cells greater than or equal to 5%,positive expression of CD71 immunophenotype,SRSF2 gene mutation,TET2 gene mutation,DNMT3A gene mutation and FLT3 gene mutation were independent risk factors for the transformation of MDS to AML.Serum lactate dehydrogenase exceeded 245U/L,peripheral blood primordial cells greater than or equal to 1%,immunophenotypic CD7 positive expression,immunophenotypic CD38 positive expression,immunop henotypic CD117 positive expression,immunophenotypic CD 123 positive expression,immunophenotypic HLA-DR positive expression,immunophenotypic cMPO positive expression have no statistical difference.All of these factors are not independent risk factors for the transformation of MDS to AML.ConclusionBone marrow primordial cells greater than or equal to 5%,immunophenotype CD71 positive expression,SRSF2 gene mutation,TET2 gene mutation,DNMT3A gene mutation and FLT3 gene mutation are independent risk factors for the transformation of MDS into AML.