The Clinical Analysis Of Biological Characteristics And Prognostic Factors Amoung Elderly Acute Myeloid Leukemia Patients

Objective:We aimed to conclude biological characteristics and analyse the prognostic factors of elderly AML patients.Methods:We assessed in the first affiliated hospital of Soochow university the distribution of biological characteristics, treatments, prognostic factors, and outcome of 204 acute myeloid leukemia patients aged 55 years or older over a 3-year period of time(2013–2015).Results:1. We analyzed the cytogenetic risk of 199 elderly AML patients. Cytogenetic risk was classified as favorable risk, n=28(14%), intermediate risk, n=90(45.3%), unfavorable risk, n=73(36.7%), and failure, n=8(4%). Somatic mutations including FLT3-ITD(21.64%),CEBPA(13.45%),DNMT3(8.77%),NPM1(22.22%) are rich in 171 patients with acute myeloid leukemia(AML)2. The percentage of leukemia cell of bone marrow(BM) is higher in patients with FLT3-ITD mutation than patients with CEBPA mutation or none. Of course, the patients with both FLT3-ITD and NPM1 mutation had a high percentage of leukemia cell in BM3. We assessed the risk by patients’ karyotype. An unfavorable-risk karyotype is more frequently observed in elderly AML patients compared with younger patients. The patients with unfavorable-risk karyotypes had a shorter overall survival(OS) than the patients with intermediate-risk karyotype. But there were no differences of OS between the patients with favorable-risk and intermediate-risk or unfavorable-risk karyotype.4. The patients with CEBPA mutation had a good drug response. The complete remission(CR) rate of patient with CEBPA can be 78.57% which is higher than the rate of patients with FLT3-ITD(33.33%), NPM1(38.46%) and the patients without mutations(49.09%).5. The patients were divided into two groups, the group treated with Decitabine and the group treated without Decitabine for survival analysis. The results showed that the median survival time of the two groups was 14 months and 9.5 months, respectively, with statistical significance(P=0.041). Obviously, the survival time of patients treated with Decitabine was significantly prolonged. We analysed first induced reaction rate of various types of leukemia treated with Decitabine, The result showed: the M2 type has a higher remission rate than that of M1 type(P = 0.036), M5 is M1 type also has higher remission rate(P = 0.018) and between the rest of the types had no obvious remission rate differences.6. In our hospital we treated with patients with supportive treatment, micro-transplantation and allogeneic transplant patient. We divided the patients to three groups: the transplantation group: 48 cases(including micro-transplantation: 34 cases, allogeneic transplantation:14 cases), non transplantation group: 94 cases, support treatment group: 15 cases. The median survival time of the three groups were 30 months, 14 months and 4 months, and the median survival time was statistically significant. The survival analysis showed that there was no significant difference in survival time between the micro transplantation group and allogeneic transplantation group.(P>0.05).7.The significant parameters of the univariate analysis were age(P=0.95),white blood cell(WBC) counts(P=0.0000),hematoglobin(HB) level(P=0.383), platelet counts(P=0.195), LDH level(P=0.003),albumin level(0.961),cytogenetic risk(0.1006), use of Decitabine(P=0.041) and allogeneic transplantation or micro-transplant(P=0.0000). Multivariate analysis showed that only increased WBC counts(WBC≥100×10E9/L) and allogeneic transplantation or micro-transplant were independent prognostic factors.Conclusion:1. In elderly AML patients, the combination of other disease factor and unfavorable cytogenetic risk made chemotherapy less efficient. High risk chromosome karyotype is more common in the elderly, and poor prognosis, such as FLT3-ITD is more likely to occur in old patients. High white blood cell, high lactate dehydrogenase, whether or not use of the Decitabine and the treatment with transplantation can affect the prognosis. Only increased WBC counts and allogeneic transplantation or micro-transplant were independent prognostic factors in AML patients over the age of 55 years. 2. Patients treated by Decitabine had a better OS and higher CR rate compared with those treated without Decitabin. If the patient had a good condition, we should cure with allogeneic transplantation or micro-transplant first.We may made the chemotherapy for the secondary choice, and cure with support care for improving their quality of life.