Clinical Characteristics And Prognostic Factors Of Acute Myeloid Leukemia With AML1-ETO Positive

Objective:To investigate the clinical characteristics of the newly diagnosed and treatment of acute myeloid leukemia(AML)with AML1-ETO positive,and to analyze the prognostic factors of AML with AML1-ETO positive,to find the prognostic signs of AML with AML1-ETO positive.Methods:Clinical data of 84 cases newly diagnosed AML with AML1-ETO positive patients who were received at least 2 courses of chemotherapy were collected in the Cancer Center of the First Hospital of Jilin University from Jan 2010 to Dec 2016.clinical characteristics and prognosis factors were analyzed retrospectively.Results:1.Clinical characteristics: Of 84 patients,including 46(54.8%)males and 38(45.2%)females.The median age was 32.5 years(range,6~62 years).68(81.0%)cases at newly diagnosed were WBC ? 20×109/L.Of 83 patients who were detected immunophenotype by flow cytometry,at least 90% of these patients expressed CD33,HLA-DR,CD13,CD34 and CD117,38 cases(45.8%)express CD19,and 58 cases(69.6%)expressed CD56.Of 83 patients who received karyotype analysis,36(43.3%)display loss of a sex chromosome(-Y/-X).Of 83 patients received mutation analysis,19(23.2%)patients with C-KIT mutation.Of 52 patients who were monitored AML1-ETO fusion transcripts quantitative,The median AML1-ETO fusion transcripts quantitative was 533.0%(range,108.7%~1300.5%).2.Initial treatment reaction and related factors: The overall after one courseinduction therapy,the CR rate was 71.4%,and the overall response rate(CR+PR)was 79.8%.The overall two courses therapy cumulative CR rate was 90.5%.The median AML1-ETO fusion transcripts quantitative(MRD)decline was 1.20 log(range,-0.73~4.85 log)after one course induction therapy.The AML1-ETO fusion transcripts quantitative decline who achieved CR after induction therapy was significantly higher than those with PR/NR(P =0.006).Drawn ROC curve which using MRD decline and OS with a Cut-off value of 1.928 log,and valued 2 log in this research.The sensitivity is 0.529,the specificity is 0.889.38.5% patients were MRD decline?2 log after induction therapy.Group of MRD decline?2 log after induction therapy had significant demographic differences compared with group of MRD decline<2 log in age,WBC and CD19 expressed(P value were 0.022,0.010 and0.042).3.Survival analysis: The median follow-up time was 17.35 months(2.30~81.00months).OS rates at one years,two years and five years were 79.4%,63.4% and58.8%,respectively.RFS rates at one years,two years and five years were 68.7%,60.3% and 58.1%,respectively.In univariate analysis: male,age > 45 years and C-KIT mutation positive were poor prognosis factors for OS.CD19 positive,IA induction chemotherapy and MRD decline?2 log after induction therapy were favorable prognosis factors for OS.Male,age>45 years and C-KIT mutation positive were poor prognosis factors for RFS.MRD decline ?2 log after induction therapy were favorable prognosis factors for RFS.Multivariate analysis showed that sex,age,C-KIT mutation,CD19 positive and MRD decline ?2 log after induction therapy were independent prognostic factors for AML with AML1-ETO positive with regard to OS,and sex,C-KIT mutation and MRD decline? 2 log after induction therapy were independent prognostic factors for RFS.Conclusions:1.AML with AML1-ETO positive is a highly heterogeneous disease.The difference exists in cell surface markers,cell genetics and molecular biological changes in different patients at newly diagnosed.2.The overall one course induction therapy CR rate > 70%.There are no significantly difference in age,peripheral blood count,marrow blasts,cell surface markers,cell genetics and molecular biological changes in induced relieving rate.The AML1-ETO fusion transcripts quantitative decline that group of CR after induction therapy is significant higher than group of PR/NR(P =0.006).3.Male patients,age>45 years and C-KIT mutation positive are independent poor prognosis factors for OS.CD19 positive and MRD decline?2 log after induction therapy are independent favorable prognosis factors for OS.Male and C-KIT mutation positive are independent poor prognosis factors for RFS.MRD decline?2log after induction therapy are independent favorable prognosis factors for RFS.