ASXL1、TET2阳性急性髓系白血病免疫表型及预后研究  

Immunophenotype and prognosis of acute myeloid leukemia patients with positive ASXL1 or TET2

作　　者：苏艳萍 杨艳丽[1] 朱锦锦 李佳佳[1] SU Yanping;YANG Yanli;ZHU Jinjin;LI Jiajia(Department of Hematology,The First Hospital of Bengbu Medical College,Bengbu 233000,Anhui,China;Department of Hematology,The First Affiliated Hospital of Soochow University,Suzhou 215006,Jiangsu,China)

机构地区：[1]蚌埠医学院第一附属医院血液科,安徽蚌埠233000 [2]苏州大学附属第一医院血液科,江苏苏州215006

出　　处：《西部医学》2024年第10期1470-1474,1479,共6页Medical Journal of West China

基　　金：安徽省自然科学基金项目(2108085QH324)。

摘　　要：目的探讨ASXL1、TET2阳性急性髓系白血病(AML)患者的免疫表型及临床预后。方法纳入2019年1月1日-2022年5月31日期间于蚌埠医学院第一附属医院就诊的162例初诊AML(M3型除外)患者的临床资料,其中ASXL1和TET2双突变组(ASXL1^(+)TET2^(+)组)患者10例,ASXL1突变组(ASXL1^(+)组,包括双突变组)患者26例,TET2突变组(TET2^(+)组,包括双突变组)患者25例,无ASXL1或TET2突变组(双阴性组)患者121例。通过对4组患者免疫表型及预后进行回顾性分析,比较4组患者的完全缓解(CR)率、中位无进展生存时间(PFS)和中位总生存时间(OS)。结果4组患者在年龄、性别、WBC、RBC、Hb、PLT计数和FAB分型上差异无统计学意义(P>0.05);与双阴性组相比,ASXL1^(+)TET2^(+)组、ASXL1^(+)组和TET2^(+)组异常染色体核型的发生频率更高(P=0.046),且初诊时骨髓原始细胞数低(P=0.037)。ASXL1^(+)组患者CD7、CD33和CD38、CD34抗原表达率低于双阴性组(均P<0.05)。CASXL1^(+)TET2^(+)组、ASXL1^(+)组和TET2^(+)组首次CR率均低于双阴性组,且ASXL1^(+)TET2+组总CR率低于双阴性组(均P<0.05)。双阴性组中位PFS和OS均较ASXL1^(+)TET2^(+)组、ASXL1^(+)组和TET2^(+)组显著延长(均P<0.05),其中ASXL1^(+)TET2^(+)组中位OS较TET2^(+)组明显缩短(P=0.019),较ASXL1^(+)组存在缩短的趋势(P=0.055)。结论ASXL1是一个不良预后的指标,合并TET2突变可能缩短了AML患者的生存时间。Objective To explore the immunophenotype and clinical prognosis of acute myeloid leukemia(AML)patients with ASXL1 or TET2 positive.Methods Clinical data of 162 patients with primary diagnosis of AML(except M3)were collected in the First Affiliated Hospital of Bengbu Medical College from January 1,2019 to May 31,2022,including 10 patients in the ASXL1 and TET2 double mutation(ASXL1^(+)TET2^(+)group),26 patients in the ASXL1 mutation(ASXL1^(+)group),25 patients in the TET2 mutation(TET2^(+)group)and 121 patients without ASXL1 or TET2 mutations(ASXL1-TET2-double negative group).The immunophenotype and prognosis of the four groups were retrospectively analyzed to compare the complete remission(CR)rate,median progression-free survival(PFS)and median overall survival(OS).Results There were no statistically significant differences in age,gender,white blood cell count,red blood cell count,hemoglobin,platelet count and FAB typing among the four groups.Compared with the ASXL1-TET2-double negative group,ASXL1^(+)group and TET2^(+)group had a higher rate of abnormal chromosome karyotype(P=0.046)and a lower bone marrow blast cell count at the time of the initial diagnosis(P=0.037).Patients in the ASXL1^(+)group had lower CD7(P=0.024),CD33(P=0.043)and CD38(P=0.023),CD34(P=0.011)antigen expression than the double negative group.The first CR rate in ASXL1^(+)TET2^(+)group(P=0.007),ASXL1^(+)group(P=0.001)and TET2^(+)group(P=0.020)was significantly lower than double negative group,and the total CR rate in ASXL1^(+)TET2^(+)group was significantly lower than double negative group(P=0.023).The median PFS and OS in the double negative group were 30 and 35 months,respectively,both of which were significantly prolonged compared with those in the ASXL1^(+)TET2^(+)group(P=0.002 and<0.001),the ASXL1^(+)group(P=0.015 and 0.005)and the TET2^(+)group(P=0.015 and 0.005).The median OS of ASXL1^(+)TET2^(+)group was significantly shorter than that of the TET2^(+)group(P=0.019),and there was a trend towards shorter OS compared with the ASXL1^(+)gr

关 键 词：急性髓系白血病 ASXL1突变 TET2突变 免疫表型 

分 类 号：R733.71[医药卫生—肿瘤]