Expression Of CD34 And Related Factors Affecting Efficacy And Prognosis In Acute Myeloid Leukemia

Background:Acute myeloid leukemia（AML）is a heterogeneous disease characterized by clonal expansion of bone marrow primitive and immature cells in the bone marrow and peripheral blood.Cytogenetic changes and gene mutations at initial treatment are important prognostic indicators in AML.However,the efficacy and prognosis of AML patients without characteristic chromosomal and genetic alterations are also different.The difference of leukemia cell immunophenotype in AML patients may affect their efficacy and prognosis.The expression of CD34 is related to the efficacy and prognosis of AML.Objective:This thesis aims to analyze the expression of CD34 in leukemia cells in the bone marrow of newly diagnosed AML patients,and to explore its correlation with clinical characteristics,bone marrow cell morphology,immunophenotype,chromosome karyotype,gene mutation,and therapeutic effect.A further efforts is made to study the related factors affecting the efficacy and prognosis of AML patientsMethods:A retrospective study was conducted on the clinical data of 155 newly diagnosed AML patients without M3 admitted to the Department of Hematology of The Second Affiliated Hospital of Nanchang University from May 2019 to December 2021.According to the expression of CD34 in leukemia cells,they were divided into CD34+group and CD34-group.This thesis analyzed and summarized their bone marrow cell morphology,immunophenotype,chromosomal karyotype,gene mutation,treatment effect,clinical outcome and other indicators.SPSS 25.0 was used for statistical analysis.Univariate analysis was carried out on the correlation between the efficacy and prognosis of AML patients with their clinical characteristics,chromosome karyotype,gene mutation,treatment plan and survival time,etc.Multivariate analysis was conducted on the efficacy and prognosis of AML patients by Logistic regression and COX regression.Results:（1）In this study,155 newly diagnosed AML patients were involved.Among them,95 were CD34+AML patients,which accounts for 61.3%;and 60 were CD34-AML patients,which accounts for 38.7%.The levels of Hb and PLT in CD34-AML patients were significantly higher than those in CD34+group.（2）According to the French,British and American（FAB）classification,there were M₀3 cases（2.1%）,M₁16 cases（16.8%）,M₂53 cases（55.8%）,M₄18cases（18.9%）,M₅6 cases（6.3%）among 95 CD34+AML patients;and there were M₀1 case（1.7%）,M₁5 cases（8.3%）,M₂13 cases（21.7%）,M₄30 cases（50.0%）,M₅11 cases（18.3%）among 60 CD34+AML patients.The proportion of M2 in CD34+AML group was significantly higher than that in CD34-group;and the proportion of M4 and M5 in CD34-AML group was significantly higher than that in CD34+group.（3）The expression rate of CD117,CD7 and HLA-DR in CD34+AML group were significantly higher than that in CD34-group,while the expression rate of CD64 was significantly lower than that in CD34-group.（4）The majority of patients in both groups had normal karyotypes.The proportion of normal karyotypes in CD34-AML group was significantly higher than that in CD34+group.The proportion of patients with poor prognosis karyotype in CD34+AML group was significantly higher than that in CD34-group.（5）The mutation rate of NPM1 and FLT3-ITD gene in CD34-AML patients were significantly higher than that in CD34-group,while the mutation rate of TP53and RUNX1 genes in CD34+AML patients were significantly higher than that in CD34-group.（6）The rate of first complete response in CD34-AML patients was significantly higher than that in CD34+group（66.1%vs 47.6%）.The median overall survival of CD34+AML patients was 19.3 months,and the median OS of CD34-group patients was not reached,survival analysis showed that the difference between the two groups was not statistically significant.（7）Univariate analysis of efficacy showed that:CD34+,high white blood cells,intermediate and poor prognosis karyotypes,RUNX1+,DNMT3A+were associated with CR1 in AML patients.Multivariate analysis suggested that CD34+,high white blood cells,poor prognosis karyotypes,RUNX1+and DNMT3A+were independent risk factors for CR1 in AML patients.（8）Univariate analysis of prognosis showed that:poor prognosis,TP53+and lack of CR1 are associated with OS in AML patients.Multivariate analysis suggested that TP53+and lack of CR1 were independent risk factors for OS.Conclusion:（1）The incidence of CD34 antigen expression in AML patients（except APL）was 61.3%,which was more common in M2 and less common in M4 and M5.（1）Relatively low levels of Hb and PLT,and relatively high expression rates of CD117,CD7 and HLA-DR,low CD64 expression rates;as well as relatively high karyotypes with poor prognosis;combined with TP53 and RUNX1 gene mutations were relatively high;and CR1 was low were characteristics of CD34+AML patients.（2）CD34 antigen,high white blood cells,poor prognosis karyotype,RUNX1gene mutation,DNMT3A gene mutation are independent risk factors for CR1 in AML patients.（3）TP53 gene mutation and lack of CR1 were independent risk factors for OS in AML patients.