| ObjectiveIn this study,we compare the clinical characteristics,laboratory characteristics,reaction to therapy and prognosis of FLT3-ITD mutant type AML and FLT3-ITD wild type AML(except M3),aiming to provide more evidence for the risk stratification and prognosis of patients withFLT3-ITD mutant type AML.MethodsIt is a clinical retrospective analysis of 340 patients who were newly-diagnosed with acute myeloid leukemia in the Hematology Department of the Second Affiliated Hospital of Kunming Medical University from January 2008 to January 2015.According to the FAB criteria,all patients were diagnosedwith AML and then receiving induction chemotherapy and post-remission therapy.All newly-diagnosed AML was divided into 55 FLT3-ITD mutant type AML and 285 FLT3-ITD wild type AML according to the results of FLT3-ITD,comparing the clinical characteristics,laboratory characteristics,induced remission rate,2-year event-free survival(EFS)and 2-year overall survival(OS).All cases were followed up to January 2017 or the date of death.Results1.Compared with FLT3-ITD wild type AML,FLT3-ITD mutant type AML had a higher peripheral blood white blood cell counts[116.1(39.4?139)*109/L vs 13.34(3.4?27.6)*109/L,Z=-4.144,P=0.000]and bone marrow blasts[74.5%(68.5%?86.0%)vs 56.5%(31.37%?70.37%),Z=-2.451,P=0.007],and the proportion of high white cell count(?100*109/L)of FLT3-ITD mutant type AML was higher than that in FLT3-ITD wild type AML[52.7%(29/55)vs23.5%(67/285),x2=19.424,P=0.000];However,there was no statistical differences each other in sex(x2=0.141,P=0.708),age(t=0.298,P=0.853),Hb(t=0.399,P=0.689)and PLT counts(Z=-1.015,P=0.083)2.The percentage of M2 in FLT3-ITD mutant type AML was 34.5%(19/55),and it was obvious lower than the percentage in FLT3-ITD wild type 55.4%(158/285)(x2=8.064,P=0.005);The percentage of M5 in FLT3-ITD mutant type AML was 49.1%(27/55),and it was obvious higher than the percentage in FLT3-ITD wild type 27.4%(78/285)(x2=10.192,P=0.001),there was no significant difference between FLT3-ITD mutant type AML and FLT3-ITD wild type in MO?M1?M4 and M6(P>0.05)?3.There was five leukemia cell surface antigen(CD33,CD11b,CD7,CD15,CD34)having statistical differences between FLT3-ITD mutant type and FLT3-ITD wild type AML.The expresssion of myeloid antigen(CD33?CD11b)and lymphoid antigen(CD7)in FLT3-ITD mutant type was higher than that in FLT3-ITD wild type AMLx2CD33=5.073,P=0.024;x2CD11b=8.069,P=0.005;x2CD7=10.820,P=0.001);The expresssion of myeloid antigen(CD15)and stem cell antigen(CD34)in FLT3-ITD mutant type was lower than that in FLT3-ITD wild type AML(x2CD15=5.427,P=0.020;x2CD34=8.667,P=0.003)?4.The proportion of abnormal karyotypes was 57.9%in AML,and most of all(60.4%)was chromosome structural aberration.Normal karyotype accounted for 34.5%(19/55)and abnormal karyotype accounted for 58.2%(32/55)in FLT3-ITD mutant type AML;Normal karyotype accounted for 37.2%(106/285)and abnormal karyotype accounted for 57.9%(165/285)in FLT3-ITD wild type AML.In good prognosis group,the proportion of FLT3-ITD mutant type AML was significantly lower than those in FLT3-ITD wild type AML(x2=4.649,P=0.031),the proportion of t(8;21)among FLT3-ITD mutant type AML was significantly lower than those in FLT3-ITD wild type AML;however,there was no significant difference between middle groups(x2=0.301,P=0.584)and poor groups.(x2=1.337,P=0.248)5.During the first induction chemotherapy course,the complete remission rate of FLT3-ITD mutant type(34.54%)was significantly lower than those in FLT3-ITD wild type AML(66.67%),P=0.0000 during the second induction chemotherapy course,the complete remission rate between FLT3-ITD mutant type and FLT3-ITD wild type AML had no difference(36.36%vs48.10%,P=0.255).But after two induction chemotherapy course,CR of FLT3-ITD mutant type(56.36%)was significantly lower than those in FLT3-ITD wild type AML(80.00%),P=0.018,the primary drug-resistance rate of FLT3-ITD mutant type(43.64%)was significantly higher than those in FLT3-ITD wild type AML(20.00%),P=0.018.6.The median survival time of FLT3-ITD mutant type AML and FLT3-ITD wild type AML were 6.8months(0.33?24.8)and 11.3months(0.12-26.6)respectively.Two-year overall survival rate of FLT3-ITD mutant type AML(28.5%)was significantly lower than that in FLT3-ITD wild type AML(55.4%),P=0.042,the differences was significant;Two-year event-free survival rate of FLT3-ITD mutant type AML(21.9%)was significantly lower than that in FLT3-ITD wild type AML(52.3%),P=0.038,the differences was significant,too.Conclusion1.FLT3-ITD mutant type AML is easy with high peripheral blood white blood cell counts and bone marrow blasts.2.The incidence of M5 of FAB classification is highest in FLT3-ITD mutant type AML(49.1%);The incidence of M2 of FAB classification is highest in FLT3-ITD wild type AML(55.4%).3.FLT3-ITD mutant type AML overexpresses myeloid antigen(CD33?CDllb)and lymphoid antigen(CD7);FLT3-ITD wild type AML overexpresses myeloid antigen(CD15)and stem cell antigen(CD34).4.The proportion of abnormal karyotypes was higher in AML,and most of all are chromosome structural aberration,FLT3-ITD wild type AML is likely to be with t(8;21)in good prognosis group.5.The complete remission rate of FLT3-ITD mutant type AML is lower,the median survival time is short,two-year event-free survival rate and two-year overall survival rate are lower,the prognosis of FLT3-ITD mutant type AML is poor. |
PDF Full Text Request