黄可秀, 王云鲭, 李迪, 邱洁蕾, 王磊, 郑雅龄, 岳春燕, 李玉华, 黄睿. 真实世界遗传学高危的急性髓系白血病患者临床结局分析[J]. 中国肿瘤临床, 2023, 50(3): 150-156. DOI: 10.12354/j.issn.1000-8179.2023.20221026
引用本文: 黄可秀, 王云鲭, 李迪, 邱洁蕾, 王磊, 郑雅龄, 岳春燕, 李玉华, 黄睿. 真实世界遗传学高危的急性髓系白血病患者临床结局分析[J]. 中国肿瘤临床, 2023, 50(3): 150-156. DOI: 10.12354/j.issn.1000-8179.2023.20221026
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Kexiu Huang, Yunqing Wang, Di Li, Jielei Qiu, Lei Wang, Yaling Zheng, Chunyan Yue, Yuhua Li, Rui Huang. Clinical outcomes of acute myeloid leukemia with genetically poor prognosis: a real-world study[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2023, 50(3): 150-156. DOI: 10.12354/j.issn.1000-8179.2023.20221026
Citation: Kexiu Huang, Yunqing Wang, Di Li, Jielei Qiu, Lei Wang, Yaling Zheng, Chunyan Yue, Yuhua Li, Rui Huang. Clinical outcomes of acute myeloid leukemia with genetically poor prognosis: a real-world study[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2023, 50(3): 150-156. DOI: 10.12354/j.issn.1000-8179.2023.20221026
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真实世界遗传学高危的急性髓系白血病患者临床结局分析

Clinical outcomes of acute myeloid leukemia with genetically poor prognosis: a real-world study

    摘要
  • 摘要:
      目的  观察标准化疗诱导的预后不良组急性髓系白血病（acute myeloid leukemia, AML）的临床特征。
      方法  回顾性分析南方医科大学珠江医院2016年1月至2020年12月收治的98例首个疗程使用标准方案化疗的预后不良组AML患者的临床和实验室资料。
      结果  预后不良组AML患者中位年龄为37（18～67）岁，其中男性占61.2%。复杂核型（30.0%）、+8（20.0%）、单体核型（18.9%）是最常见的细胞遗传学异常，FLT3-ITD（34.1%）、ASXL1（20.5%）、RUNX1（15.9%）、DNMT3A（15.9%）、TET2（15.9%）是最常见的基因突变，其首疗程完全缓解率为37.8%。中位总生存期（median overall survival，mOS）和中位无事件生存期（median event-free survival，mEFS）分别是17个月和6个月，中位无复发生存期（median relapse-free survival， mRFS）为12个月。移植方面，有55例患者进行了异基因造血干细胞移植，中位随访16个月，mOS尚未达到，显著高于未移植组的9个月（P<0.001）。移植后1年及2年累积复发率分别是22.7%及31.8%，1年的非复发死亡率为15.8%。此外，对于34例首个疗程诱导后评估为未缓解的患者，不同方案的治疗效果比较显示：CAG±去甲基化药物方案相较于标准“3+7”方案具有更高的再诱导完全缓解率（77.8% vs. 23.1%；P=0.027）。
      结论  预后不良组AML患者缓解率低，复发率高，生存期短。对于首疗程诱导化疗效果较差的预后不良组AML，CAG联合去甲基化药物是一种可考虑的再诱导方案。

     

    Abstract:
      Objective  To evaluate the clinical outcomes of acute myeloid leukemia (AML) with poor prognosis induced by standard chemotherapy.
      Methods  The clinical and laboratory data of 98 AML patients with poor prognosis treated with standard chemotherapy during their first induction therapy who were admitted at Zhujiang Hospital of Southern Medical University from January 2016 to December 2020 were retrospectively analyzed.
      Results  In the AML patients with poor prognosis, the mean age was 37 (18–67) years, and 61.2% were men. Complex karyotype (30.0%), +8 (20.0%) and monosomal karyotype (18.9%) were the most common cytogenetic abnormalities. Besides, FMS-like tyrosine kinase 3-internal tandem duplications (FLT3-ITD) (34.1%), additional sex combs like-1 (ASXL1) (20.5%), runt-related transcription factor 1 (RUNX1) (15.9%), DNA methyltransferase 3 alpha (DNMT3A) (15.9%), and TET methylcytosine dioxygenase 2 (TET2) (15.9%) were the most common gene mutations. The complete remission rate following the first course of treatment was 37.8%. The median overall survival (mOS) and median event-free survival (mEFS) times were 17.0 and 6.0 months, respectively. The median relapse-free survival (mRFS) was 12.0 months. In terms of transplantation, 55 patients had undergone allogeneic hematopoietic stem cell transplantation with a median follow-up of 16.0 months, while the mOS was not yet reached, which was significantly higher than 9.0 months in patients who did not undergo transplantation (P< 0.001). The analyses of relapse after transplantation showed that the cumulative relapse rates at 1 and 2 years after transplantation were 22.7% and 31.8%, respectively. The non-relapse mortality rate at 1 year after transplantation was 15.8%. In 34 AML patients with no remission after the first course of induction therapy, the comparison of the therapeutic effects of different regimens showed that treatment with CAG±hypomethylating agents showed better reinduced complete remission compared with the standard “3+7” regimens (77.8% vs. 23.1%; P=0.027).
      Conclusions  AML patients assigned to the poor prognosis group have low remission rate, high relapse rate, and short survival time. CAG combined with hypomethylating agents may be considered as a reinduction option for AML patients with poor prognosis who respond poorly to the first course of induction chemotherapy.

     

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