| Background:Acute myeloid leukemia?AML? is a group of heterogeneous,clonal hematologic malignancies that originate from hematopoietic stem/progenitor cells.Leukemia cells are arrested in cell development due to increased proliferative capacity,differentiation,and apoptotic disorders.Primitive,naive stage[1].In the past,the diagnostic classification of domestic AML was performed by FAB classification.According to the morphological and cytochemical staining characteristics,there were 7 subtypes of M1-M7[2].With the development of techniques such as flow cytometry,karyotype analysis and gene detection,the clinical diagnosis of AML is currently based on MICM classification,which is comprehensively considered from the aspects of morphology,immunophenotype,cytogenetics and molecular biology.The diagnostic classification of AML is more precise and scientific,and is of great significance for guiding treatment and prognosis.Combining the prognostic risk stratification of cytogenetics and molecular biology has become an important basis for the treatment options and prognosis of acute myeloid leukemia at home and abroad,but the existing prognostic stratification system is still unable to accurately evaluate the prognosis of this type of patients[3].Therefore,it is still necessary to analyze the clinical characteristics of acute myeloid leukemia and the factors affecting the prognosis of the treatment.Based on this,the research project is designed to provide more evidence for AML stratified diagnosis and treatment of evidence-based medicine.Objective:Retrospective study of clinical data of 120 patients with newly diagnosed non-M3 AML admitted to our hospital from May 2015 to December 2018,and analysis of clinical baseline data,immunophenotype,karyotype,fusion gene,and gene mutation Characteristics,and analysis of the efficacy and prognosis of the first induction chemotherapy.Materials and Methods:The clinical data of 120 patients with newly diagnosed acute myeloid leukemia?AML?non-M3 admitted to the Department of Hematology,Second Affiliated Hospital of Nanchang University from May 2015 to December 2018 were collected and screened,including the gender and age of onset.First diagnosis,first blood routine,bonemarrowcellmorphology,immunophenotype,cytogenetics?chromosomal karyotyping?,molecular genetics?fusion gene and gene mutation?,FAB typing,lactate dehydrogenase,peripheral blood primitive Cell ratio,chest CT,abdominal CT or color Doppler ultrasound data were collected,and the patient's treatment plan was collected and the prognosis was followed up.The data was analyzed and statistically analyzed using SPSS 25.0 software,and Graphpad prism8software was used for graphic drawing.Results:1.Age of onset,gender,FAB classification,initial diagnosis:120 patients with a median age of onset of 55 years;male to female ratio of 1.22:1;FAB classification consisted of:M2 58 cases,M5 22 cases,M4 18 cases,M1 18 cases,2 cases of M6and 2 cases of M7;39.2%of patients had pulmonary infection,14.2%had lymphadenopathy,and 35.0%had liver and/or splenomegaly.2.The median value of the initial diagnosis of blood:at the initial diagnosis,the median WBC 19.65×109/L,HGB 74g/L,PLT 34×109/L,LDH 412.7U/L,peripheral blood blast cell ratio 0.50,bone marrow blast cell ratio 0.650 There were15 cases of high white blood cells,34 cases of severe anemia,and 31 cases of severe thrombocytopenia.3.Immunophenotype:In this group of non-M3 AML,myeloid antigen expression:CD13>CD117>CD33>CD64>MPO>CD15>CD11b>CD14;naivecell antigen expression:HLA-DR>CD34;lymphoid antigen expression:CD56>CD7>CD19.4.Karyotype:abnormal karyotype detection rate of 46.67%,non-complex abnormal karyotype t?8;21??q22;q22?with or without other abnormalities in 16cases,simple+8 abnormalities in 5 cases,inv?16?3 cases of abnormality,del?11??q23?,-7/del?7?,del?5??q22?,inv?9??p12q13?,t?8;12;21??q22;P13;q22?,t?9;21??p22;q23?were abnormal in 1 case and 13 in other karyotypes.The karyotype prognosis risk grade was 20 cases?16.7%?in the good group,84 cases?70%?in the middle group,and 16 cases?13.3%?in the bad group.According to the type of abnormality,there were 26 cases?21.7%?with structural abnormalities,10 cases?8.3%?with abnormal numbers,and 20 cases?16.7%?with abnormal number and structure.5.112 cases of fusion gene detection:positive cases of 43 cases?38.39%?,common fusion genes:AML1-ETO gene 18 cases?16.07%?;CBF?-MYH11 gene 7cases?6.25%?.6.97 cases of gene mutation:mutation rate:NPM1 27.45%,FLT3-ITD 14.29%,FLT3-TKD 0%,C-Kit 7.32%,CEBPA single mutation 11.63%,double mutation11.63%,DNMT3A mutation 18.18%,TP53 0%,RUNX1 8.33%.7.The first induction of chemotherapy efficacy:CR 54 cases?45%?,CRi 12cases?10%?,PR13 cases?10.83%?,NR 41 cases?34.17%?;first induction chemotherapy complete remission rate?CR1%?55%.8.Single factor analysis of efficacy showed:LDH?U/L?,bone marrow blast cell ratio,lymph node enlargement,PLT greater than 20?109/L?,whether CAG-containing regimen was associated with CR1%;multivariate analysis showed:When the initial diagnosis of PLT was less than 20×109/L,the first induction chemotherapy CR1%was low.9.Prognostic single factor analysis showed that age of onset?60 years old?,bone marrow blast cell ratio?with 0.75 boundary?,PLT?bounded to 20×109/L?,and the first induction of chemotherapy with CR1 and no CR1 may affect Prognosis;multivariate analysis of prognosis showed that the age of onset was?60 years old,and the mean OS was short in the first induction chemotherapy without CR1,and the prognosis was poor.Conclusion:1.The initial diagnosis of PLT less than 20×109/L first induction chemotherapy CR1%low;onset age?60 years old,the first induction chemotherapy did not reach CR1,the average OS is short,the prognosis is poor.2.Acute myeloid leukemia has unique cytogenetic and molecular biological characteristics.The factors that can affect the efficacy and prognosis of patients are numerous and complex.A reasonable and accurate risk stratified diagnosis should be performed at the initial diagnosis,combined with the patient's blood routine.According to factors such as age,choose appropriate treatment plan,develop individualized treatment,improve curative effect and improve prognosis. |
PDF Full Text Request