| Objective: Explore the correlation between the percentage of peripheral blood blasts on day 7(D7PBBP)of induction chemotherapy and response to therapy and prognosis in AML patients.Try to establish a AML prognostic stratification system based on D7 PBBP.Methods: Retrospective analysis of 137 patients with de novo AML(non-acute promyelocytic leukemia)who had blasts in the peripheral blood circulation from the Department of Hematology,the First Hospital of Jilin University from October 2015 to October 2018.All patients were diagnosed by morphology,immunophenotype,cytogenetics,and molecular mutation examination.The percentage of peripheral blood blasts on day 7 of induction chemotherapy were detected by flow cytometry?The patients of previous study were used as training group,and the patients were included in this study as verification group.Further verify the cut-off value of training group and explore the relationship between the D7 PBBP and chemotherapy response and prognosis in AML patients.Results: 1?137 patients received 1 course of treatment with DA / IA,100 patients achieved complete remission(CR),of which 48 achieved MRD negative remission,12 achieved partial remission(PR),and 25 did not respond(NR).CR rate was 73%(100/137),MRD negative remission rate was 35%(48/137),PR rate was8.75%(12/137),ORR was 81.75%(112/137).2?Previous study(training group): D7 PBBP was significantly correlated with 1course of treatment achieved CR,ROC curve determined that D7 PBBP value was0.945%,which could be used as the cut-off point to judge whether the patients could achieve CR.The study results of verification group show: D7 PBBP was significantly correlated with CR and MRD negative remission of 1 course of treatment(all P<0.001).The CR rate and MRD negative remission of patients with D7PBBP<0.945% in verification group were significantly higher than those in D7PBBP?0.945%(P<0.001;P=0.014).The D7 PBBP of induction chemotherapy in patients in verification group was associated with bone marrow residue on the day 14?28 of induction chemotherapy(r = 0.384,P <0.001;r = 0.499,P <0.001).3?A total of 106 patients were included in survival analysis,the follow-up time ranged from 3 to 43 months,and median follow-up time was 14 months.Among them,24 patients died(22.64%,24/106)and 33 patients relapsed(31.13%,33/106).The 1and 3 years OS were 84.2% and 65.2%,1 and 3 years RFS were 71.2% and 55.1%,respectively.Previous study(training group): D7 PBBP was significantly correlated with OS and RFS,ROC curve determined that D7 PBBP value was 0.43%,which could be used as the cut-off point to judge the long-term survival of patients.The verification group also found that D7 PBBP was significantly correlated with OS and RFS(r =-0.222,P=0.022;r=-0.308,P=0.001).The OS and RFS in D7 PBBP <0.43% group were higher than those in D7 PBBP ?0.43% group(P=0.001;P= 0.006).Cytogenetic-molecular stratification and D7 PBBP were included in the survival analysis,the patients in the low-intermediate risk group were subdivided into different subgroups according to the D7 PBBP level.The results showed that OS and RFS in low-intermediate risk group with D7 PBBP ?0.43% were lower than those in low-intermediate risk group with D7PBBP<0.43%(P =0.032;P =0.125),and all were close to those in the genetically stratified high risk group.4 ? Univariate analysis showed that : Positive FLT3-ITD mutation,failure to achieve CR in 1 course of treatment,and D7 PBBP ? 0.43% were the adverse prognostic factors affecting patients' OS and RFS,while men was the adverse prognostic factor for RFS.COX multivariate analysis showed that: failure to achieve CR in 1 course of treatment and D7 PBBP ? 0.43% were independent adverse prognosis factors affecting patients' OS.Men,failure to achieve CR in 1 course of treatment and positive FLT3-ITD mutation were independent adverse prognostic factors affecting patients' RFS.Conclusion : 1 ? The D7 PBBP of induction chemotherapy has a significant correlation with the CR and MRD negative remission of 1 course of treatment,and the D7 PBBP cut-off value of 0.945% can evaluate the efficacy of induction chemotherapy.2?The D7 PBBP of induction chemotherapy was associated with bone marrow residue on day 14?28 of induction chemotherapy.3?The D7 PBBP was significantly correlated with OS and RFS.The D7 PBBP cut-off value of 0.43% can be used as an evaluation index for long-term survival of AML patients.In the low-intermediate risk group of cytogenetic-molecular,patients can be subdivided into different prognosis subgroups according to the level of D7 PBBP.4? COX multivariate analysis showed that: D7 PBBP level is an independent prognostic factor affecting patients 'OS.5 ? A prognostic layering system for AML can be established based on the D7 PBBP level. |
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