| Objective:1.To understand the clinical manifestations and molecular characteristics of patients with FLT3-ITD mutation(FLT3-ITDmut)in acute myeloid leukemia(AML).2.To observe the efficacy of sorafenib combined with chemotherapy in the treatment of FLT3-ITDmut AML evaluated by observing the induced remission(Complete remission,CR)rate,total survival(overall survival,OS)rate,and event-free survival(event-free survival,EFS)rate,and the safety of sorafenib was analyzed by observing the adverse reactions of sorafenib treatment.Methods:From January 2016 to December 2018,a total of 42 cases of primary FLT3-ITDmut acute myeloid leukemia admitted to Liyi Central Hospital and diagnosed by MICM typing were collected.The clinical data and laboratory test results of 42 patients were collected,and their clinical characteristics were analyzed,then follow up their biological characteristics of these patients were studied.Among 42 patients with FLT3-ITDmut AML 17 patients were treated with sorafenib combined with conventional chemotherapy,and 25 patients were treated with simple routine chemotherapy.The initial dose of sorafenib was 400 mg bid/day,and oral treatment,monitoring blood routine and evaluating the adjusted dosage of sorafenib tolerance(200-800 mg/d,when the patient developed granulocytosis).Continuous oral administration for 14 days,every 28 days is 1course of treatment.The effective rate(ORR),median survival time,adverse reactions,and tolerance of sorafenib combined chemotherapy were observed.Results:1.Clinical and molecular biological characteristics of FLT3-ITD mut patients.The clinical features of 42 cases of primary FLT3-ITDmut AML(non-M3 type)included: the highest proportion of FAB type M5 subtype(47.6%);The proportion of bone marrow primordial cells was high in peripheral blood.molecular biology detection FLT3-ITDmut AML is easy to accompany NPMl,WT1,CEBPA double mutation,AML1-ETO,DNMT3 A,IDH1RUNX1-RUNX1T1,etc.2.Effect of sorafenib combined with chemotherapy on FLT3-ITDmut AML.The total induced remission rate was 59.5% in 42 patients.The induction therapy in the sorafenib group was superior to that in chemotherapy,with one cycle remission rate82.3% Vs44%.The treatment remission and the difference in initial induced remission rate between the two groups were statistically significant(P<0.01).The Sorafenib group did not increase the mortality rate associated with primary induction remission treatment by 5.8% Vs 8.0%.Survival analysis showed that the OS rates in the sorafenib group and chemo group were 78.3% Vs 50.0%(P=0.026<0.05),the difference was statistically significant.The annual PFS rates of the two groups were 75.9% Vs 42.4%(P=0.029<0.05),the difference was statistically significant.3.Analys safety of sorafenib combined with chemotherapy in FLT3-ITDmut AML.There was no significant difference in the degree and duration of bone marrow suppression in 17 patients with the sorafenib group.And with the extension of the course of treatment,the patient’s condition relief,hematological adverse reactions gradually improved.Non-hematological adverse reactions were gastrointestinal reactions and rashes,After giving treatment,their condition improved and did not affect the treatment.There was no damage to heart and kidney function.Conclusion:1.FLT3-ITD mut acute myeloid leukemia has the clinical characteristics of a high proportion of leukocytes and bone marrow primordial cells,a higher rate of NPM1 gene mutation,and a high degree of M5 subtype.2.Sorafenib combined with chemotherapy in the treatment of FLT3-ITD mut acute myeloid leukemia in remission rate is good.After mitigation allogeneic hematopoietic stem cell transplantation and post-transplantation maintenance treatment effect.3.The adverse reactions of sorafenib were bone marrow suppression,skin rash,gastrointestinal reaction,chapped skin of hand and foot,and it could be effectively controlled and safe after timely symptomatic support treatment. |
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