老年急性髓系白血病患者临床特征与预后分析  

Clinical Characteristics and Prognosis in Elderly Patients with Acute Myeloid Leukemia

作　　者：令狐顺 肖青[1] 王欣[1] 唐晓琼[1] 张红宾[1] 罗小华[1] 刘林[1] 陈建斌[1] 杨泽松[1] 王利[1] LINGHU Shun;XIAO Qing;WANG Xin;TANG Xiaoqiong;ZHANG Hongbin;LUO Xiaohua;LIU Lin;CHEN Jianbin;YANG Zesong;WANG Li(The First Affiliated Hospital of Chongqing Medical University,Chongqing,China 400016)

机构地区：[1]重庆医科大学附属第一医院,重庆400016

出　　处：《中国药业》2023年第12期66-71,共6页China Pharmaceuticals

基　　金：重庆市科卫联合医学科研项目[2018ZDXM001]。

摘　　要：目的探讨老年急性髓系白血病(AML)的基因突变及预后因素。方法选取医院血液科2015年1月至2020年12月收治的年龄≥60岁的AML患者183例,将其中86例接受化学药物治疗(简称化疗)的患者分为标准化疗组(12例)和低强度化疗组(74例);采用实时荧光定量聚合酶链式反应和DNA测序技术对133例患者行基因突变检测。分析患者基因突变情况及预后影响因素。结果患者的基因突变频率为88.72%(118/133),突变频率排名前5的基因分别为WT1(60.90%)、NPM1(22.56%)、IDH2(12.78%)、DNMT3A(10.53%)、FLT3-ITD(9.77%)。多(≥2个)基因突变频率为46.62%(62/133),常见的共存突变基因为WT1+NPM1(16.54%)、WT1+IDH2(9.02%)、WT1+FLT3-ITD(8.27%)、WT1+DNMT3A(7.52%)。WT1+FLT3-ITD及WT1+DNMT3A突变患者的中位生存期均显著短于WT1+NPM1突变患者(P<0.05)。低强度化疗组的完全缓解(CR)率和客观缓解(OR)率分别为49.02%和62.75%,高于标准化疗组的33.33%和50.00%(P>0.05)。多因素分析结果显示,年龄≥70岁、难治、复发、诱导治疗1~2个疗程未达CR、FLT3-ITD突变是影响老年AML患者总生存期的独立不良预后因素。结论老年AML患者的基因突变频率较高,常存在共存突变,WT1合并FLT3-ITD或DNMT3A突变的患者总生存期短,多种因素可影响预后,诱导治疗选择低强度化疗可在一定程度上提高疗效。Objective To investigate the gene mutations and prognostic factors in elderly acute myeloid leukemia(AML).Methods A total of 183 AML patients aged≥60 years admitted to the Department of Hematology in the hospital from January 2015 to December 2020 were selected.Among them,86 patients who received chemotherapy were divided into the standard chemotherapy group(12 cases)and the low-intensity chemotherapy group(74 cases).Real-time fluorescence quantitative polymerase chain reaction and DNA sequencing were used to detect the gene mutations in 133 patients.The gene mutations and prognostic factors in patients were analyzed.Results The frequency of gene mutations in patients was 88.72%(118/133),that of WT1 was the highest(60.90%),followed by NPM1(22.56%),IDH2(12.78%),DNMT3A(10.53%)and FLT3-ITD(9.77%).The frequency of multi-gene(≥two genes)mutations was 46.62%(62/133),and the common co-existing mutant genes were WT1+NPM1(16.54%),WT1+IDH2(9.02%),WT1+FLT3-ITD(8.27%)and WT1+DNMT3A(7.52%).The median survival time(MST)of patients with WT1+FLT3-ITD and WT1+DNMT3A mutations was significantly shorter than that of patients with WT1+NPM1 mutations(P<0.05).The complete remission(CR)rate and objective remission(OR)rate in the low-intensity chemotherapy group were 49.02%and 62.75%respectively,which were higher than 33.33%and 50.00%in the standard chemotherapy group(P>0.05).The results of multivariate analysis showed that age≥70 years,refractoriness,recurrence,failure to achieve CR after one to two courses of induction therapy and FLT3-ITD mutations were the independent poor prognostic factors affecting the overall survival(OS)of elderly patients with AML.Conclusion Elderly patients with AML have a high frequency of gene mutations and often have co-existing mutations.Patients with WT1+FLT3-ITD or WT1+DNMT3A mutations have a shorter OS,and multiple factors can affect prognosis.The low-intensity chemotherapy for induction therapy can improve the efficacy to a certain extent.

关 键 词：老年患者 急性髓系白血病 基因突变 预后 化学药物治疗 

分 类 号：R969.3[医药卫生—药理学] R933.71[医药卫生—药学]