Children's Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
Hematol Oncol. 2022 Apr;40(2):258-268. doi: 10.1002/hon.2951. Epub 2021 Nov 27.
To evaluate the outcome and prognostic significance of CEBPA mutations among pediatric acute myeloid leukemia (AML) from TARGET dataset. A total of 1803 pediatric patients who were diagnosed with AML were classified into two groups based on the CEBPA status by using a retrospective cohort study method from September 1996 to December 2016. The incidence of CEBPA mutations was 18%. CEBPA mutations were significantly associated with elder age (p < 0.001), higher WBC (p = 0.004), higher proportion of peripheral blood blast (p < 0.001), normal karyotype (p < 0.001), low risk (p < 0.001) and higher complete remission induction rates (p < 0.05). Overall, CEBPA mutations patients had a significantly better 5-year EFS (p < 0.001) and OS (p < 0.001) compared to CEBPA wild-type patients, and this favorable impact was maintained even in the presence of FLT3/ITD mutations. Stem cell transplantation had no significant impact on the survival of patients with coexistence of CEBPA and FLT3/ITD mutations. Multivariate analysis demonstrated that mutated CEBPA were an independent favorable indicators of better outcome in terms of EFS (p = 0.007) and OS (p = 0.039). Our study demonstrate mutated CEBPA have an excellent outcome in pediatric AML patients. Furthermore, pediatric AML patients with coexistence of CEBPA and FLT3/ITD mutation appear to have favorable prognoses and might not required stem cell transplantation.
评估 TARGET 数据集中小儿急性髓系白血病(AML)中 CEBPA 突变的结果和预后意义。采用回顾性队列研究方法,从 1996 年 9 月至 2016 年 12 月,对 1803 例诊断为 AML 的儿科患者进行分组,根据 CEBPA 状态将其分为两组。CEBPA 突变的发生率为 18%。CEBPA 突变与年龄较大(p<0.001)、白细胞计数较高(p=0.004)、外周血原始细胞比例较高(p<0.001)、核型正常(p<0.001)、低危(p<0.001)和完全缓解诱导率较高(p<0.05)显著相关。总体而言,与 CEBPA 野生型患者相比,CEBPA 突变患者的 5 年 EFS(p<0.001)和 OS(p<0.001)显著更好,即使存在 FLT3/ITD 突变,这种有利影响也得以维持。干细胞移植对 CEBPA 和 FLT3/ITD 突变共存患者的生存没有显著影响。多变量分析表明,突变型 CEBPA 是 EFS(p=0.007)和 OS(p=0.039)更好结局的独立有利指标。本研究表明,突变型 CEBPA 使小儿 AML 患者具有出色的预后。此外,共存 CEBPA 和 FLT3/ITD 突变的小儿 AML 患者似乎具有良好的预后,可能不需要进行干细胞移植。