Clinical Characteristics And Prognosis Of Patients With Complex Karyotype Acute Leukemia

Background:Acute leukemia(AL)is a malignant clonal disease of hematopoietic stem cells.With the improvement of medical treatment and the application of new treatment methods,the prognosis of acute leukemia has made some progress.However,with the development of molecular biology and cytogenetics in recent years,it has been recognized that the chromosome changes of AL not only reflect the biological nature of AL at the molecular genetic level,but also have important diagnostic and prognostic values for chromosome aberrations.Chromosome abnormalities include changes in number and structure,which are divided into normal karyotype(NK),monosomic karyotype(MK)and complex karyotype(CK)according to their degree of involvement in chromosome abnormalities.When more than two chromosomes and / or chromosome aberrations with more than three break sites are involved,they are complex karyotypes.Complex karyotypes not only occur in hematological tumors,but also in solid tumors.At present,the incidence of complex karyotype AL in AL patients is low,but many studies have shown that the remission rate is low and the prognosis is very poor.At present,there is no effective treatment for complex karyotype AL.In order to improve the remission rate and prognosis,the treatment measures were constantly changed according to the specific curative effect of the patients.ObjectiveTo investigate the clinical features and prognosis of AL)patients with complicated karyotype.MethodsFrom October 2008 to June 2018,281 patients with AL diagnosed by our hospital from October 2008 to June 2018(excluding acute promyelocytic leukemia and 24 patients with failed bone marrow chromosome culture)were selected as screening subjects,including complex karyotype.There were 33 cases of non-complex karyotype AL,248 cases of complex karyotype AL,33 cases of complex karyotype al as the study group,and 43 cases of control group were randomly selected from 248 cases of noncomplex karyotypic AL patients.All patients were examined with bone marrow morphology,bone marrow immune typing,chromosome karyotype and fusion gene.The clinical and laboratory data were summarized,and the relationship between clinical features and prognosis was analyzed.ResuitsIn this study,the incidence of complex karyotype AL in patients with AL(excluding acute promyelocytic leukemia)was 11.7%(33/281,AML 11.2%,ALL 12.8%).There was no significant difference in sex,age,blood cells,bone marrow and peripheral blood primordial cells,positive rate of bone marrow CD34 and extramedullary infiltration between patients with complex karyotype AL and non-complex karyotype AL(P>0.05).However,the difference of hematopoietic history or morbid hematopoiesis was statistically significant(P=0.010).The rate of complete remission(CR)in patients with complex karyotype AL was 59.4%,which was lower than that in non-complex karyotype AL patients(85%)(P=0.023).The rate of CR in(AML)patients with complex karyotype was 47.6%,which was lower than that in AML patients without complex karyotype(79.3%)(P=0.020).The rate of CR with high karyotype complexity in patients with complex karyotype AL was lower than that of CR with low karyotype complexity(P=0.036).Survival analysis was performed with Kaplan-Meier.The median relapse free survival time(RFS)in complex karyotype group and non-complex karyotype group was 162 days,462 days,and the median survival time(OS)was 256 days and 769 days,respectively.The difference was statistically significant(P= 0.002,<0.001).AML,the median OS of the two groups was 125 days and 741 days,respectively.In patients with acute lymphoblastic leukemia(ALL),the median OS of the two groups were 293 days and 939 days,respectively.The difference was statistically significant(P=<0.001,008).ConclusionsCompared with non-complex karyotype AL patients with complex karyotype AL had previous history of hematologic malignancy or hematopoietic morbid hematopoiesis.The rate of CR,RFS and OS in patients with complex karyotype AL were lower than those with non complex karyotype AL at the same time.Patients with complex karyotype AL have high chromosome complexity and low CR rate.The CR rate of complex karyotype AML was lower and OS shorter than that of non-complex karyotypic AML patients.The ALL of complex karyotype was shorter than that of noncomplex karyotypic ALL patients and OS was shorter than that of non-complex karyotypic ALL patients.