| Objective:To investigate the cytogenetics characteristics in patients with de novo acute myeloid leukemia(AML),and to explore the related factors of prognosis for AML patients,in order to improve the accuracy of the analysis and evaluation.Methods:The study selected 401 patients of de novo AML from January 2011 to June 2013 of the First Hospital of Jilin University,the patients were diagnosed by MICM,exclude the patients with medical history of myelodysplastic syndrome(MDS)and bone marrow hyperplastic disease,treatment-related AML,myeloid sarcoma,shorter hospitalization time and did not finish one course of chemotherapy.Reference to the WHO classification standards for2016 to diagnosis,and according to the NCCN Version 2.2016,divide the 401 cases of AML patients into the favorable risk category,intermediate risk category and poor risk category.Karyotype was analyzed by G-banding technology,and clonal abnormalities were defined and described according to the International System for Human Cytogenetic Nomenclature(2009)[3].ToVII compare the clinical symptoms and blood test results between this three groups,analysis the therapeutic efficacy and prognosis,and investigate their relationship with overall survival(OS)and relapse-free survival(RFS),the statistical analysis by SPSS 22.0.Results:1.Cytogenetics analysis The chromosome karyotype abnormal rate was68.83%(276/401)of AML patients,and the favorable risk category,intermediate risk category,poor risk category,constituent ratio of three categories was 54.11%(217/401),35.41%(142/401),10.48%(42/401).In the favorable risk category,the highest detection rate was 38.4%(154/401),which was t(15;17),followed by t(8;21),12.47%(50/401)and inv(16)/t(16;16)with low detection rate,3.24%(13/401).In the intermediate risk category,the detection rate of t(9;11)was 2.24%(9/401),+8 alone was 1.75%(7/401).And in the Poor risk category: the detection rate of complex karyotype,monosomal karyotype,-5/5q-,-7/7q was respectively 3.99%(16/401),1.75%(7/401),2.24%(9/401),and 2.0%(8/401).2.The comparison of clinical and hematologic features between three categories Gender,bone marrow hyperplasia degree,the original cell and its equivalent cell in peripheral blood,neutrophil count,red blood cell count,hemoglobin concentration had no statistical difference between the three groups categories(P>0.05).Age,the original cell and its equivalent cell in bone marrow,myeloid:erythroid ratio,white blood cell count,platelet count,patients with bleeding as the main symptoms had statistical difference between the three groups categories(P<0.05).Futher more,the favorable risk category had smaller age,white blood cell count,platelet count than intermediate risk category,but had higher the original cell and its equivalent cell in bone marrow,myeloid:erythroid ratio and more patients with bleeding as the main symptoms,(P <?',adjusted ?'=0.017).The favorable risk category had smaller age,white blood cell count,platelet count than poor risk category,but had higher myeloid:erythroid ratio and more patients with bleeding as the main symptoms(P values were<0.017).The intermediate risk category and poor risk category in the above factors had no statistical difference(P values were>0.017).3.The comparison of CR rate after initial induction therapy between three categories Their CR rate was 90.32%(196/217),60.56%(86/142),42.86%(18/42),respectively,inter-group difference was statistically significant(P<0.05).Futher more,the favorable risk category in CR rate is higher than intermediate risk category(P<0.001)and poor risk category(P<0.001),while the CR rate in intermediate and poor risk category had no statistical difference(P=0.245).4.The comparison of prognosis between three categories Their median OS was 40 months,31 months,15 months,and the estimate 3-year OS was50.8%±5.9%,39.7%±5.4%,21.6%±8.9%,respectively.While,the median RFS was 35 months,14 months,7 months,and the estimate 3-year RFS was45.2%±6.3%,17.5%±4.6%,10.9%±5.7%,respectively,inter-group differencewas statistically significant(P<0.05).5.Prognosis factor analysis in AML Log-rank test showed that age,the first induction chemotherapy treatment efficacy,chromosome karyotype,peripheral blood leukocyte count,and FLT3-ITD gene were the related factors that influenced the OS prognosis of AML patients(P<0.05).COX multivariate analysis showed that the factors including age(RR=2.52,95%CI 1.67~3.80,P<0.05),the first induction chemotherapy treatment efficacy(RR=2.49,95%CI1.96~3.17,P<0.05),chromosome karyotype(RR=1.60,95%CI 1.19~2.14,P<0.05)were the independent prognostic factors for OS in patients with de novo AML.Conclusions:1.Acute myeloid leukemia patients with abnormal karyotype detection rate was 68.83%,the detection rate from high to low was: favorable risk category,intermediate risk category and poor risk category.2.Patients in favorable risk category had smaller age,white blood cell count,platelet count than intermediate and poor risk category,but had higher myeloid:erythroid ratio and more patients with bleeding as the main symptoms.3.Age,the first induction chemotherapy treatment efficacy and chromosome karyotype were the independent prognostic factors for OS in patients with de novo AML. |
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