Wen Xiang-Mei, Lin Jiang, Yang Jing, Yao Dong-Ming, Deng Zhao-Qun, Tang Chun-Yan, Xiao Gao-Fei, Yang Lei, Ma Ji-Chun, Hu Jia-Bo, Qian Wei, Qian Jun
Department of Hematology, Affiliated People's Hospital of Jiangsu University Jiangsu 212002, Zhenjiang, People's Republic of China.
Laboratory Center, Affiliated People's Hospital of Jiangsu University Jiangsu 212002, Zhenjiang, People's Republic of China.
Int J Clin Exp Pathol. 2014 Sep 15;7(10):6832-40. eCollection 2014.
This study is aimed to investigate the pattern of CEBPA mutations and its clinical significance in Chinese non-M3 acute myeloid leukemia (AML) patients. The entire coding region of CEBPA gene was amplified by PCR and then sequenced in samples from 233 non-M3 AML patients. Fifty mutations were identified in 37 (15.8%) patients with eleven (4.7%) double mutated CEBPA (dmCEBPA) and twenty-six (11.1%) single mutated CEBPA (smCEBPA). dmCEBPA was exclusively observed in M1 and M2 subtypes of FAB classification (P = 0.008), whereas smCEBPA occurred in almost all subtypes (P = 0.401). Patients with dmCEBPA had significantly younger age and higher WBC counts than those with wtCEBPA (P = 0.016 and 0.043, respectively). Both dmCEBPA and smCEBPA were mainly present in cytogenetically normal patients. Patients with dmCEBPA achieved higher rate of complete (CR) than wtCEBPA patients (88% vs. 51%, P = 0.037), whereas smCEBPA and wtCEBPA groups are similar (47% vs. 51%, P = 0.810). Patients with dmCEBPA had a superior overall survival (OS) compared with patients with wtCEBPA (P = 0.033), whereas patients with smCEBPA had a similar OS as patients with wtCEBPA (P = 0.976). dmCEBPA but not smCEBPA was also associated with favorable outcome in patients with wild-type NPM1 and FLT3-ITD (NPM1(wt)FLT3-ITD(wt) ). Our data confirm that dmCEBPA but not smCEBPA is prognostically favorable in NPM1(wt)FLT3-ITD(wt) AML, and suggest that the entity AML with mutated CEBPA should be definitely designated as AML with dmCEBPA in WHO classification and smCEBPA should be excluded from the favorable risk of molecular abnormalities.
本研究旨在探讨中国非M3型急性髓系白血病(AML)患者中CEBPA基因突变模式及其临床意义。采用聚合酶链反应(PCR)扩增233例非M3型AML患者样本中CEBPA基因的整个编码区,随后进行测序。在37例(15.8%)患者中鉴定出50个突变,其中11例(4.7%)为双突变CEBPA(dmCEBPA),26例(11.1%)为单突变CEBPA(smCEBPA)。dmCEBPA仅在FAB分类的M1和M2亚型中观察到(P = 0.008),而smCEBPA几乎在所有亚型中均有出现(P = 0.401)。与野生型CEBPA(wtCEBPA)患者相比,dmCEBPA患者年龄显著更小,白细胞计数更高(分别为P = 0.016和0.043)。dmCEBPA和smCEBPA主要存在于细胞遗传学正常的患者中。dmCEBPA患者的完全缓解(CR)率高于wtCEBPA患者(88%对51%,P = 0.037),而smCEBPA组与wtCEBPA组相似(47%对51%,P = 0.810)。与wtCEBPA患者相比,dmCEBPA患者的总生存期(OS)更长(P = 0.033),而smCEBPA患者的OS与wtCEBPA患者相似(P = 0.976)。在野生型核仁磷酸蛋白1(NPM1)和FMS样酪氨酸激酶3内部串联重复(FLT3-ITD)(NPM1(wt)FLT3-ITD(wt))患者中,dmCEBPA而非smCEBPA也与良好预后相关。我们的数据证实,在NPM1(wt)FLT3-ITD(wt)AML中,dmCEBPA而非smCEBPA具有预后优势,并表明在世界卫生组织(WHO)分类中,CEBPA突变的AML实体应明确指定为dmCEBPA型AML,而smCEBPA应排除在有利分子异常风险之外。