Department of Hematology, Oita Kouseiren Tsurumi Hospital, Oita, Japan.
Department of Medical Oncology and Hematology, Faculty of Medicine, Oita University, 1-1 Hasama Idaigaoka, Yuhu City, Oita, 879-5593, Japan.
Int J Hematol. 2020 Jul;112(1):17-23. doi: 10.1007/s12185-020-02871-4. Epub 2020 Apr 6.
Terminal deoxynucleotidyl transferase (TdT) is expressed on precursor lymphoblastic neoplasms and some acute myeloid leukemia (AML) cells. The clinical impact of TdT expression on AML outcomes remains unclear. Here, we conducted a retrospective analysis to identify prognostic implications of TdT expression in AML with an intermediate-risk karyotype. Forty-eight cases of intermediate-risk AML were enrolled. TdT positivity was defined as expression on ≥ 10% of the gated cells. Of 48 cases, 12 (25%) were positive for TdT [median expression rate of TdT 0.9% (range 0-86.9%)]. No significant differences in patient characteristics or complete remission rate were observed between TdT-positive and TdT-negative cases. The probability of overall survival (OS) and event-free survival (EFS) at 1 year was not significantly different between TdT-positive and TdT-negative cases (OS: 58.3% vs. 65.2%, p = 0.32; EFS: 33.3% vs. 57.1%, p = 0.06). Relapse-free survival (RFS) probability at 1 year was significantly lower for TdT-positive than TdT-negative cases (10% vs. 71.3%, p = 0.002). Multivariate analyses revealed that TdT positivity was an independent significant adverse factor for RFS [hazard ratio: 3.309, 95% confidence interval: 1.334-8.209, p = 0.009]. Our results suggest that TdT expression is associated with increased risk of relapse in patients with intermediate-risk AML.
端粒酶（TdT）在前体淋巴母细胞性肿瘤和一些急性髓系白血病（AML）细胞中表达。TdT 表达对 AML 结局的临床影响尚不清楚。在这里，我们进行了一项回顾性分析，以确定中间风险核型 AML 中 TdT 表达的预后意义。共纳入 48 例中间风险 AML 患者。TdT 阳性定义为 gated 细胞上表达≥10%。在 48 例病例中，有 12 例（25%）为 TdT 阳性[TdT 表达的中位数为 0.9%（范围 0-86.9%）]。TdT 阳性和 TdT 阴性病例在患者特征或完全缓解率方面无显著差异。1 年时总生存（OS）和无事件生存（EFS）的概率在 TdT 阳性和 TdT 阴性病例之间无显著差异（OS：58.3%比 65.2%，p=0.32；EFS：33.3%比 57.1%，p=0.06）。1 年时 TdT 阳性病例无复发生存（RFS）的概率显著低于 TdT 阴性病例（10%比 71.3%，p=0.002）。多变量分析显示，TdT 阳性是 RFS 的独立不良因素[风险比：3.309，95%置信区间：1.334-8.209，p=0.009]。我们的研究结果表明，TdT 表达与中间风险 AML 患者的复发风险增加相关。
