| Background:Acute myeloid leukemia is a disease caused by malignantly proliferating,clonal and abnormally differentiated cells of the hematopoietic system infiltrating the bone marrow,blood and other tissues,accounts for 20%to 30%of acute leukemia in children.Clinical manifestation with fever,anemia,bleeding and marrow infiltration characteristics.In recent years,with the widespread use of combination chemotherapy and hematopoietic stem cell transplantation(HSCT),its efficacy has improved significantly.The overall survival rate(OS)of most clinical research collaborative groups has reached 60%-70%,and the event-free survival rate(EFS)exceeds 50%,but still 30%-40%of children will relapse,which is still one of the reasons for the poor prognosis of AML patients.Research suggests that AML recurrence associated with leukemia stem cell(LSC).CD123 is not or lowly expressed in normal hematopoietic stem cells,but highly expressed on the surface of AML cells and LSC,which suggest CD123 is one of the main signs of AML-LSC.CD123,also known as interleukin-3 receptor alpha chain,forms a high-affinity IL-3 receptor together with CD131,which promotes proliferation and differentiation of hematopoietic stem cells and inhibits apoptosis of hematopoietic cells by binding to IL-3 ligands.In addition,the high expression of CD 123 in tumor cells can promote proliferation and reduce apoptosis of tumor cells.Previous studies have shown CD123 positive rate of about 38.9%-77.9%.Foreign studies have shown that high CD 123 expression is associated with adverse outcomes in patients with AML.However,there are few studies on the relationship between CD 123 expression and prognosis of pediatric AML patients in China.Objective:By analyzing the CD 123 expression and clinical characteristics of 106 children with AML(except APL),the clinical characteristics and prognostic effects of CD 123 expression in childhood with AML(except APL)were explored.Methods:The clinical case data of 106 children with AML(except APL)who were first diagnosed and met the inclusion criteria from January 1,2015 to December 31,2018 in the Children’s Hematology and Oncology Department of the First Affiliated Hospital of Zhengzhou University were collected for research.After obtaining informed consent from the family,4 ml of bone marrow fluid was collected from all children before the start of chemotherapy,and the expression rate of CD123 in AML was measured by fluorescence multiparameter flow cytometry.① Divided 106 cases of AML(excluding APL)into CD 123 positive group and CD 123 negative group according to the expression level of CD 123,and analyzed the differences in clinical characteristics,laboratory tests,remission rate and prognosis-related indicators of AML children between the two groups;② To analyze the risk factors affecting the remission rate of children with AML(excluding APL);③ To analyze the prognosis of CD 123 positive group and CD 123 negative group in AML children with different risk stratification;④ Multivariate analysis of risk factors affecting the prognosis of children with AML(excluding APL).Results:1.Among the 106 children with AML(excluding APL),there were 47 children(44.3%)in the CD 123 positive group,the male to female ratio was about 1.24:1,and the median age of onset was 92 months.Compared with the CD123 negative group,the newly diagnosed white blood cell count and the proportion of bone marrow blasts in the CD 123-positive group of children with AML were higher,and the differences were statistically significant(P<0.05).The CD 123 positive rate in each FAB type was M6>M4>M5>M1>M2,it was negative in AML-M7,CD 123 positivity was lower in AML-M2(P=0.006<0.05)but higher in AML-M4(P=0.043,<0.05)and the difference was statistically significant.2.The first induction complete remission rate(59.5%)in the CD 123 positive group was significantly lower than the CR rate(86.2%)in the CD123 negative group,and the difference was statistically significant(P=0.004<0.05).Multivariate Logistic regression analysis showed that positive CD 123 expression was an independent risk factor for the first induction remission rate in children with AML.The total recurrence rate of 106 children with AML(excluding APL)was 29.25%(31/106),and the recurrence rate of CD 123 positive group(34.0%)was higher than that of CD 123 negative group(25.4%),and the difference was not statistically significant(P=0.392>0.05).3.Among children with AML(excluding APL)with different risk stratification,there was no difference in the 3-year survival rate,event-free survival rate between the CD 123-positive group and the CD 123-negative group in the low-risk and high-risk groups.Statistical significance(P>0.05),among the children in the intermediate-risk group,the 3-year survival rate(39.1%vs 81.3%)and the 3-year event-free survival rate(29.2%vs 65.5%)of the CD123 positive group were lower than those of CD 123.In the negative group,and there were significant differences in these indicators between the two groups(P<0.05).4.COX proportional hazards regression model showed that the positive expression of CD 123 and leukocyte count were risk factors affecting the overall survival rate(OS)of AML patients.In addition,the positive expression of CD 123 was an influencing factor of OS and EFS in children with intermediate-risk AML.Conclusions:1.Compared with the CD 123-negative group,the CD 123-positive group had higher white blood cell counts,higher proportion of bone marrow blasts.CD123 positivity was lower in AML-M2 but higher in AML-M4,and the difference was statistically significant.2.The positive expression of CD 123 is an independent risk factor affecting the first induction remission rate in children with AML.3.The positive expression of CD 123 leukocyte count are risk factors affecting the overall survival rate(OS)of AML patients.In addition,the positive expression of CD 123 is an influencing factor of OS and EFS in children with intermediate-risk AML. |
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