Prongostic Value Of Dynamic Monitoring Of AML1-ETO Transcript Levels In Pediatric Acute Myeloid Leukemia

ObjectiveThis study aims to investigate the prognostic value of dynamic monitoring of AML1-ETO transcript levels in pediatric patients with t(8;21)acute myeloid leukemia(AML).MethodsThe clinical features and experimental results of 55 pediatric t(8;21)AML patients newly diagonsed in our department from Jan.2010 to Apr.2016 were analyzed retrospectively.The relationgship between the minimal residual disease(MRD)and recurrence or prognosis were analysed by continuous monitoring of AML1-ETO transcript levels using real-time quantitative PCR(RQ-PCR)technology.ResultsThe AML1-ETO transcript levels in bone marrow cells at diagnosis was not related to recurrence and prognosis.After one course of induction therapy,for patients with a more than 2 Log reduction of AML1-ETO transcript levels with respect to the levels at diagnosis(a>2 Log),compared to patients with a less than 2 Log reduction(a<2 Log),5 years cumulative incidence of relapse(CIR),disease free survival(DFS)and overall survival(OS)were:(24.3±8.4)% vs(52.6±9.7)%(P=0.003),(71.6±12.7)% vs(48.1±13.2)%(P=0.016)and(76.9±12.5)% vs(48.9±14.7)%(P=0.012),respectively.Multivariate Cox survival analysis suggested that after a course of induction therapy,a > 2 Log reduction in AML1-ETO transcript levels was an independent prognostic factor for RFS and OS.During consolidation therapy and follow-up period,continuous dynamic monitoring of AML1-ETO transcript levels indicated that median time interval from the molecular relapse to blood recurrence was 4 months.2 cases of patients with molecular relapse who received timely allogeneic hematopoietic stem cell transplantation(allo-HSCT)did not experience hematologic relapse.ConclusionsDynamic monitoring of AML1-ETO transcript levels by RQ-PCR technique can subvide patients into relatively low and high risk group,early recognize patients at high risk of relapse and provide a scientific basis for precision stratification and risk-adapted therapy for t(8;21)AML children.