allo-HSCT前后DEK-NUP214融合基因的变化及其对急性髓系白血病患者治疗和预后的临床意义  

Changes of DEK-NUP214 fusion gene before and after allo-HSCT and its clinical significance in patients with acute myeloid leukemia before and after transplantation

作　　者：韦柳源 杨帆[2] 高海娥 肖秀丽 WEI Liu-yuan;YANG Fan;GAO Hai-e(Blood Purification Room,The Second Affiliated Hospital of Hainan Medical College,Haikou Hainan 570311,China;Hepatobiliary and Pancreatic Surgery,The Second Affiliated Hospital of Hainan Medical College,Haikou Hainan 570311,China)

机构地区：[1]海南医学院第二附属医院血液净化室,海南海口570311 [2]海南医学院第二附属医院肝胆胰外科,海南海口570311

出　　处：《临床和实验医学杂志》2023年第11期1152-1155,共4页Journal of Clinical and Experimental Medicine

基　　金：海南省科技计划项目(编号:2021FZ-066)。

摘　　要：目的探讨急性髓系白血病患者异基因造血干细胞移植(allo-HSCT)前后DEK-NUP214融合基因的变化及其对治疗和预后的临床意义。方法回顾性选取2019年2月至2022年2月海南医学院第二附属医院急性髓系白血病患者60例,DEK-NUP214均为阳性,均接受allo-HSCT治疗,分析移植前后DEK-NUP214融合基因表达、移植后微小残留病(MRD)阳性患者的治疗及预后。结果移植前DEK-NUP214阳性52例,中位表达水平为0.38%(0.03%~738.90%),3年累积复发率(CIR)为(17.42±2.12)%,移植相关死亡率(TRM)为(24.42±4.22)%,无病生存率(DFS)为(61.42±13.42)%,总生存率(OS)为(60.42±13.75)%;阴性8例,移植后未复发或死亡。移植后DEK-NUP214阳性36例,阴性24例。Kaplan-Meier显示,DEK-NUP214阳性患者具有较差的预后。移植后DEK-NUP214阳性36例,移植1个月后,表达水平降低了500(5.70~5663.00)倍,持续DEK-NUP214阳性8例,随访期间复发;移植2个月后,因严重预防移植物抗宿主病死亡4例;移植6个月后,DEK-NUP214基因阴性24例;移植3年后,DEK-NUP214阳性患者具有较高的CIR,为(27.02±4.64)%,DEK-NUP214阴性患者未复发。DEK-NUP214阳性患者的TRM为(23.75±3.47)%,高于DEK-NUP214阴性患者[(16.62±2.51)%],差异有统计学意义(P<0.05),但二者的DFS、OS比较,差异均无统计学意义(P>0.05)。60例患者的白细胞数为(8.23±1.25)×10^(9)/L,血小板数为(66.25±10.42)×10^(9)/L,血红蛋白水平为(81.52±10.56)g/L,DEK-NUP214水平为(488.56±81.23)%;输注中性粒细胞(8.81±1.23)×10^(8)/kg,输注CD34+细胞(1.75±0.23)×10^(6)/kg,白细胞植活时间为(14.23±2.56)d,血小板植活时间为(16.85±2.42)d;急性移植物抗宿主病20例,慢性移植物抗宿主病4例,白血病复发8例,死亡20例,其中死于复发8例,治疗相关死亡12例。结论急性髓系白血病患者allo-HSCT前后DEK-NUP214融合基因变化明显,能够对MRD状态进行敏感有效评估。Objective To investigate the changes of DEK-NUP214 fusion gene before and after allo-HSCT transplantation in patients with acute myeloid leukemia and its clinical significance.Methods Sixty patients with acute myeloid leukemia in The Second Affiliated Hospital of Hainan Medical College from February 2019 to February 2022 were retrospectively selected.All patients were positive for DEK-NUP214 and received allo-HSCT transplantation.The expression of DEK-NUP214 fusion gene before and after transplantation and the treatment and prognosis of patients with MRD positive after transplantation were analyzed.Results There were 52 cases of DEK-NUP214 positive before transplantation,and the median expression level was 0.38%(0.03%-738.90%),3-year cumulative recurrence rate(CIR)was(17.42±2.12)%,transplant-related mortality(TRM)was(24.42±4.22)%,disease-free survival rate(DFS)was(61.42±13.42)%,overall survival(OS)was(60.42±13.75)%.There were 8 negative cases and no recurrence or death after transplantation.After transplantation,36 cases of DEK-NUP214 were positive and 24 cases were negative.Kaplan-Meier showed that patients who were positive for DEK-NUP214 had a poor prognosis.There were 36 cases of DEK-NUP214 positive after transplantation.One month after transplantation,the expression level was reduced by 500(5.70-5663.00)times,and 8 cases of persistent DEK-NUP214 positive patients recurred during follow-up.Two months after transplantation,4 patients died due to severe graft-versus-host disease.Six months after transplantation,24 cases of DEK-NUP214 gene were negative.Three years after transplantation,DEK-NUP214 positive patients had a higher CRI of(27.02±4.64)%,and DEK-NUP214 negative patients had no recurrence.The TRM of DEK-NUP214 positive patients was(23.75±3.47)%,which was higher than that of DEK-NUP214 negative patients(16.62±2.51)%,the difference was statistically significant(P<0.05),but there was no statistically significant difference in DFS and OS between the two patients(P>0.05).The white blood cell count of

关 键 词：急性髓系白血病 ALLO-HSCT DEK-NUP214融合基因 预后 

分 类 号：R733.71[医药卫生—肿瘤]