诱导化疗序贯异基因造血干细胞移植治疗FLT3-ITD突变阳性伴正常染色体核型急性髓系白血病的临床研究  

Clinical study of induction chemotherapy followed by allogeneic hematopoietic stem cell transplantation in the treatment of FLT3-ITD+acute myeloid leukemia with normal karyotype

作　　者：李芳 刘燕平 朱晗[1] 洪鸣[1] 钱思轩[1] 朱雨[1] 沈文怡[1] 陈丽娟[1] 何广胜[1] 吴汉新[1] 陆化[1] 李建勇[1] 缪扣荣[1] Li Fang;Liu Yanping;Zhu Han;Hong Ming;Qian Sixuan;Zhu Yu;Shen Wenyi;Chen Lijuan;He Guangsheng;Wu Hanxin;Lu Hua;Li Jianyong;Miao Kourong(Department of Hematology,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院,江苏省人民医院血液科,南京210029

出　　处：《中华血液学杂志》2023年第3期230-235,共6页Chinese Journal of Hematology

摘　　要：目的评估诱导化疗序贯异基因造血干细胞移植治疗FLT3-ITD突变阳性伴正常染色体核型急性髓系白血病(AML)的疗效。方法对2018年1月至2021年3月南京医科大学第一附属医院收治的FLT3-ITD+伴正常染色体核型AML患者进行回顾性分析。结果49例FLT3-ITD+AML患者纳入研究,男31例,女18例,中位年龄46(16~59)岁。所有患者均接受诱导化疗,24例患者序贯异基因造血干细胞移植(移植组)。中位随访时间为465 d,确诊后1年总生存(OS)率为(70.0±7.4)%,1年无病生存(DFS)率为(70.3±7.4)%。移植组、非移植组1年OS率分别为(85.2±7.9)%、(52.6±12.3)%(P=0.049),DFS率分别为(84.7±8.1)%、(55.2±11.9)%(P=0.061)。在移植组和非移植组中,FLT3-ITD低频突变与高频突变患者1年OS率差异均无统计学意义(P>0.05)。移植组、非移植组中各有12例FLT3-ITD高频突变患者,1年OS率分别为(68.8±15.7)%、(26.2±15.3)%(P=0.027),1年DFS率分别为(45.5±21.3)%、(27.8±15.8)%(P=0.032)。结论诱导化疗序贯allo-HSCT可改善FLT3-ITD+患者(特别是FLT3-ITD高频突变患者)的预后。Objective To assess the efficacy of induction chemotherapy followed by allogeneic hematopoietic stem cell transplantation(allo-HSCT)in the treatment of FLT3-ITD+acute myeloid leukemia(AML)with normal karyotype.Methods The clinical data of FLT3-ITD+AML patients with normal karyotype in the First Affiliated Hospital of Nanjing Medical University from Jan 2018 to March 2021 were retrospectively analyzed.Results The study included 49 patients with FLT3-ITD+AML,31 males,and 18 females,with a median age of 46(16-59)years old.All patients received induction chemotherapy,and 24 patients received sequential allo-HSCT(transplantation group).The median follow-up time was 465 days,the one-year overall survival(OS)from diagnosis was(70.0±7.4)%,and one-year disease-free survival(DFS)was(70.3±7.4)%.The one-year OS was significantly different between the transplantation group and the non-transplantation group[(85.2±7.9)%vs(52.6±12.3)%,P=0.049].but one-year DFS[(84.7±8.1)%vs(55.2±11.9)%,P=0.061]was not.No significance was found in one-year OS between patients with low-frequency and high-frequency FLT3-ITD+(P>0.05).There were 12 patients with high-frequency FLT3-ITD+in the transplantation and the non-transplantation groups,respectively.The one-year OS[(68.8±15.7)%in the transplantation group vs(26.2±15.3)%in the non-transplantation group,P=0.027]and one-year DFS[(45.5±21.3)%in the transplantation group vs(27.8±15.8)%in the non-transplantation group,P=0.032]were significantly different between the two groups.Conclusion Induction chemotherapy followed by allo-HSCT can enhance the prognosis of FLT3-ITD+patients,particularly those with FLT3-ITD high-frequency mutation.

关 键 词：白血病 髓系 急性 FLT3-ITD突变 异基因造血干细胞移植 预后 

分 类 号：R733.71[医药卫生—肿瘤]