联合CD19和KITD816进一步优化t(8;21)急性髓系白血病预后分层  

CD19 combined with KITD816 for optimization of prognostic stratification of t(8;21) acute myeloid leukemia

作　　者：王彪[1] 林榕榕 杨斌[1] 李海乾[1] 邢姗姗 张修文[3] 谢晓宝[1] 严峰[1] Wang Biao;Lin Rongrong;Yang Bin;Li Haiqian;Xing Shanshan;Zhang Xiuwen;Xie Xiaobao;Yan Feng(Department of Hematology,Changzhou First People's Hospital,Changzhou 213000,China;Department of Hematology,Zhejiang Hospital,Hangzhou 310013,China;Department of Hematology,Nanjing Medical University Affiliated Changzhou Second Hospital,Changzhou 213000,China)

机构地区：[1]常州市第一人民医院血液科,江苏常州213000 [2]浙江医院血液科,浙江杭州310013 [3]南京医科大学附属常州二院血液科,江苏常州213000

出　　处：《中华临床医师杂志（电子版）》2019年第8期589-595,共7页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的分析当前治疗模式下的t(8;21)急性髓系白血病(AML)患者的缓解和预后异质性,为进一步个体化治疗提供依据。方法收集2014年10月至2018年9月常州市第一人民医院107例标准方案诱导的成人初治t(8;21)AML患者,综合传统MICM和二代测序(NGS)基因突变特征,应用多因素Logistic和Cox回归分析,评价完全缓解(CR)率、累积复发率、无事件生存(EFS)和总生存(OS)的影响因素。结果诱导1个疗程后,CR率为79.0%(83/105),早期死亡率为1.9%(2/107)。多因素分析显示,KIT-D816突变阳性是不良影响CR率[HR=3.29(1.18~9.24),P=0.023]、EFS[HR=3.53(1.82~6.84),P=0.000]和OS[HR=5.45(1.77~16.84),P=0.003]的唯一独立因素。CD19表达阴性是唯一独立预测累积复发率增加的不利因素[HR=0.32(0.10~1.00),P=0.050]。而KIT突变、KIT-N822和复杂核型对任何终点均不构成独立意义。结论建议将特定的KIT-D816突变而非KIT突变纳入t(8;21)AML危险分层体系;CD19表达阴性的t(8;21)AML患者复发风险增加,需密切监测。Objective To analyze the heterogeneity of remission and prognosis of patients with t(8;21) acute myeloid leukemia (AML) under current treatment modalities,and to provide a basis for further risk-adapted treatment.Methods A total of 107 adult patients with primary t(8;21) AML treated with the standard 3 + 7 regimen at Changzhou First People's Hospital from October 2014 to September 2018 were collected.The complete remission (CR) rate,cumulative incidence of relapse,event-free survival (EFS), and overall survival (OS) were evaluated by combining the characteristics of traditional Morphology, Immunology,Cytogenetics,and Molecular biology (MICM) and genetic mutations based on next-generation sequencing (NGS) using multivariate Logistic and Cox regression analyses.Results After a single induction course,the CR rate was 79.0%(83/105) and the early mortality rate was 1.9%(2/107).Multivariate analysis showed that positive KIT-D816mut was the only independent factor adversely affecting the CR rate (hazard ratio [HR]=3.29 [1.18-9.24],P=0.023),EFS (HR=3.53 [1.82-6.84],P=0.000),and OS (HR=5.45 [1.77-16.84], P=0.003).Negative CD19 expression was the only independent predictor of increased cumulative incidence of relapse (HR=0.32 [0.10-1.00],P=0.050).KITmut,KIT-N822,and complex karyotype were not independent risk factors for all endpoints.Conclusions It is suggested that the specific KIT-D816mut,rather than general KITmut,should be included in the risk stratification system of t(8;21) AML.Patients with negative CD19 have an increased risk of relapse,which requires close monitoring.

关 键 词：t(8 21) 急性髓系白血病 CD19 二代测序 KIT 预后 

分 类 号：R733.71[医药卫生—肿瘤]