CD7^(+)复发难治急性髓系白血病患者的临床特征及异基因造血干细胞移植预后分析  

Clinical features and prognosis of CD7^(+)relapsed or refractory acute myeloid leukemia patients after allogeneic hematopoietic stem cell transplantation

作　　者：郝启 危薇 顾江英[1] 刘新月 王世泽 秦贞烩 费新红[1] 王静波[1] Hao Qi;Wei Wei;Gu Jiangying;Liu Xinyue;Wang Shize;Qin Zhenhui;Fei Xinhong;Wang Jingbo(Department of Hematology,Aerospace Center Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院血液科,北京100049

出　　处：《中华检验医学杂志》2023年第12期1298-1304,共7页Chinese Journal of Laboratory Medicine

摘　　要：目的探讨CD7^(+)复发难治急性髓系白血病(r/r AML)患者的临床及分子学特征以及异基因造血干细胞移植术(allo-HSCT)的预后。方法回顾性分析2017年1月1日到2020年12月31日入航天中心医院血液科行allo-HSCT的172例r/r AML患者,根据初发免疫表型是否表达CD7分为CD7^(+)组75例,CD7-组97例。采用Mann-Whitney U和卡方检验对比两组患者的临床资料、分子学及细胞遗传学特征,Kaplan-Meier分析两组患者的中位无进展生存时间(PFS)和中位总生存时间(OS),Cox回归筛选影响患者预后因素。结果中位随访19个月,CD7-组复发率23.71%,CD7^(+)组复发率50.67%(χ^(2)=13.428,P<0.001)。复发患者中CD7-组86.96%不表达CD7,CD7^(+)组86.84%表达CD7。CD7-组和CD7^(+)组的中位无进展生存时间(PFS)分别为25个月和5个月,差异有统计学意义(χ^(2)=13.428,P=0.003);中位总生存时间(OS)分别为34个月和15个月,差异有统计学意义(χ^(2)=2.579,P=0.108)。单因素分析显示,CD7^(+)组患者移植前获得形态学缓解率较低(χ^(2)=10.014,P=0.002),获得分子学缓解率较低(χ^(2)=22.809,P<0.001),男性患者较多(χ^(2)=5.281,P=0.022),CEBPA双位点突变发生率高于CD7-组(23.4%比8.2%,χ^(2)=8.180,P=0.004),RUNX1::RUNX1T1融合基因发生率低于CD7-组(4.0%比18.6%,χ^(2)=8.362,P=0.004)。多因素分析显示,移植前肿瘤负荷是影响r/r AML患者PFS和OS的唯一预后因素,PFS(HR 1.600,95%CI 1.203~2.127,P=0.001);OS(HR 1.737,95%CI 1.273~2.369,P<0.001)。结论CD7阳性可作为r/r AML患者不良预后的危险因素,且复发后CD7表达稳定,可以作为免疫靶向治疗的靶点。Objective To investigate the clinical and molecular features of patients with CD7^(+)relapsed or refractory acute myeloid leukemia(r/rAML)and the prognosis of allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods 172 r/rAML patients who underwent allo-HSCT in department of hematology,Aerospace Center Hospital between January 1st 2017 and December 31st 2020 were retrospectively analyzed The patients were were divided into CD7^(+)group(n=75)and CD7-group(n=97)according to the expression CD7 in the initial immunophenotype.Mann-Whitney U and Chi-square test were used to compare the clinical data,molecular and cytogenetic characteristics of the two groups of patients.Kaplan-Meier method was used to analyze the median progression-free survival(PFS)and median overall survival(OS)of the two groups of patients,and Cox regression screenthe prognostic factors of the patients.Results The median follow-up time was 19 months.The recurrence rates were 23.71%and 50.67%,respectively in CD7-and CD7^(+)group(χ^(2)=13.428 P<0.001).In relapsed patients,86.96 percentage of CD7-group did not express CD7 while 86.84 percentage of CD7^(+)group expressed CD7.The median PFS was 25 and 5 months in CD7-and CD7^(+)group(χ^(2)=8.695,P=0.003),and the medianOS was 34 and 15 months in CD7-and CD7^(+)group(χ^(2)=2.579,P=0.108).Univariate analysis showed that the CD7^(+)group,had the lower rates of morphological remission(χ^(2)=10.014,P=0.002),molecular remission(χ^(2)=22.809,P<0.001),and more male patients(χ^(2)=5.281,P=0.022).The incidence of CEBPA double-site mutation was higher(23.4%vs 8.2%,χ^(2)=8.180,P=0.004)and the rearrangement of RUNX1::RUNX1T1 was lower(4.0%vs18.6%,χ^(2)=8.362,P=0.004)in CD7^(+)group than in CD7-group.Multivariate analysis showed that pre-transplant tumor load was the only prognostic factor for PFS(HR,1.600;95%CI,1.203 to 2.127;P=0.001)and OS(HR,1.737;95%CI,1.273 to 2.369;P<0.001)in r/r AML patients.Conclusion CD7 expression is a risk factor for poor prognosis in r/r AML patients,and CD7 expression

关 键 词：白血病 髓样 急性 流式细胞术 抗原 CD7 异基因造血干细胞移植 预后 

分 类 号：R733.71[医药卫生—肿瘤]