AML1/ETO阳性急性髓系白血病患者FLT3基因高表达及其临床意义  

FLT3 Gene Overexpression and Its Clinical Significance in Acute Myeloid Leukemia with AML1 /ETO Fusion Gene Positive

作　　者：谢惠敏[1] 高丽[2] 王楠[1] 徐媛媛[1] 石金龙[3] 于力[1] 王莉莉[1] 

机构地区：[1]中国人民解放军总医院血液科,北京100853 [2]中日友好医院血液科,北京100029 [3]中国人民解放军总医院医学工程保障中心,北京100853

出　　处：《中国实验血液学杂志》2014年第5期1199-1205,共7页Journal of Experimental Hematology

基　　金：国家自然科学基金面上项目(81370636;81170517;30973394);北京市自然科学基金;面上项目(7102142)

摘　　要：本研究旨在探讨AML1/ETO融合基因阳性的急性髓系白血病M2(acute myeloid leukemia with maturation,AML/M2)患者FLT3基因表达量与临床症状和预后的相关性及其意义。采用RQ-PCR法定量检测21例AML1/ETO阳性AML-M2患者初诊骨髓标本中FLT3基因的表达水平,并分析FLT3基因表达量的高低与临床特征、实验室其它检测结果及预后的关系。结果表明:患者FLT3基因表达水平(FLT3基因/内参基因)初诊时为1.65%-261.5%。据此将FLT3基因表达水平大于35%者归为高表达组(12例),其表达水平低于35%者归为低表达组(9例)。高表达组患者初诊时白细胞计数>10×109/L者8例(66.67%),低表达组2例(22.22%);伴有髓外浸润患者的比例在高表达组为25%,低表达组为0%,但由于例数较少,暂无统计学意义(P=0.0805;P=0.2286)。两组患者年龄以及骨髓原始细胞比例无明显差异(P=0.1369,P=0.6923)。FLT3基因高表达组和低表达组化疗完全缓解(CR)率为(66.67%vs 88.89%),其差异无统计学意义(P=0.3383),而复发率(66.67%vs 22.22%)及死亡率(50%vs 22.22%)的差异虽无统计学意义(P=0.0805,P=0.3666),但有很明显的差异趋势。结论:AML1/ETO阳性AML-M2患者FLT3基因表达量高提示患者预后不良,易复发,常规检测初诊AML1/ETO阳性AML-M2患者骨髓中FLT3基因表达量对患者的危险度分层、预后评估以及个体化治疗方案的选择可能具有重要的指导意义。This study was aimed to investigate the expression levels of FLT3 gene in AML-M2 patients carrying AML1/ETO fusion gene,and analyze its relation with clinical and laboratorial features and prognosis.RQ-PCR method was used to detect the expression level of FLT3 in bone marrow of 21 AML-M2 patients with AML1/ETO ＋.The correlation of the expression level of FLT3 with clinical features,other laboratorial examinations and disease prognosis were analyzed.The results showed that gene expression level of FLT3 （FLT3 gene/reference gene） in patients at initial diagnosis were 1.65%-261.5%.The expression level of FLT3 over 35% was defined as high expression group（12 cases）,while the expression level below 35% was defined as low expression group（9 cases）.The proportion of patients with extramedullary infiltration in high expression group was higher than that in low expression group （25% vs 0%,P =0.2286）.The proportion of patients at initial diagnosis with white blood cell count 〉 10 × 109/L in high expression group was higher than that in low expression group（66.67% vs 22.22%）,but there was no statistical significance（P =0.0805）.No significant difference was observed at the age （P =0.1369） and the rate of bone marrow blasts （P =0.6923） between the above mentioned two groups.The differences in complete remission rate （66.67% vs 88.89%,P =0.3383）,the relapse rate （66.67 % vs 22.22%,P =0.0805） and the mortality rate （50% vs 22.22%,P =0.3666） between the two group were not significant,but there was a clear trend that the low expression group has a higher CR rate and a lower relapse rate and mortality rate.It is concluded that FLT3 gene high expression in AML-M2 patients with AML1/ETO＋ have a higher rate of relapse and hence poor prognosis.Therefore,detection of FLT3 expression level in routine clinical practice is important for patient＇s risk stratification,prognostic evaluation and effective treatment selection.

关 键 词：急性髓系白血病 AML1/ ETO FLT3 

分 类 号：R733.71[医药卫生—肿瘤]