Zhou Nai-Cen, Li Guo-Hui, Qin Wei-Wei, Wang Wen-Qing, Guo Huai-Peng, Liu Cong, Liu Li
Department of Hematology, The Second Affiliated Hospital of Air Force Medical University (Tangdu Hospital), Xi'an 710038, Shaanxi Province, China.
Department of Hematology, The Second Affiliated Hospital of Air Force Medical University (Tangdu Hospital), Xi'an 710038, Shaanxi Province, China,E-mail:
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2022 Jun;30(3):755-759. doi: 10.19746/j.cnki.issn.1009-2137.2022.03.015.
To investigate the characteristics of gene mutation in elderly patients with acute myeloid leukemia (AML) and its effect on prognosis.
The clinical and laboratorial characteristics of 54 AML patients (≥60 years old) in Department of Hematology, Tangdu Hospital were analyzed retrospectively during April 2016 to October 2019. Thirty-four AML/myelodysplastic syndrome/myeloproliferative neoplasm related mutant genes were detected by second-generation sequencing technology, and their clinical characteristics, treatment effect, and influence on prognosis were analyzed.
All the patients received DAC+CAG induction treatment, after 1-2 couses of treatment, 36 cases (66.7%) achieved complete response, with a total effective rate of 75.9%, and the median survival time was 17 months. The most frequent mutant genes were TET2 (33.3%), CEBPA (31.5%), DNMT3A (18.5%), ASXL1 (16.7%), NRAS (14.8%), RUNX1 (14.8%), FLT3-ITD (12.9%), TP53 (12.9%), NPM1 (12.9%), and IDH2 (12.9%). Among 7 patients with TP53 mutation, 6 cases obtained complete response after 1-2 courses of induction treatment, but there was no statistically significant difference in the effect on prognosis. Patients with FLT3-ITD and NRAS mutations had shorter overall survival time compared with who had no mutation (P=0.47, P=0.48). Multivariate analysis showed that FLT3-ITD and NRAS mutations were poor prognostic factors.
The incidence of TET2 gene mutation is high in elderly AML patients. AML patients with TET2 and TP53 mutations may benefit from Decitabine-based chemotherapy. However, patients with FLT3-ITD and NRAS mutations have a short survival time, and may have a poor prognosis.
探讨老年急性髓系白血病（AML）患者基因突变特征及其对预后的影响。
回顾性分析2016年4月至2019年10月唐都医院血液科54例年龄≥60岁的AML患者的临床及实验室特征。采用二代测序技术检测34个AML/骨髓增生异常综合征/骨髓增殖性肿瘤相关突变基因，并分析其临床特征、治疗效果及对预后的影响。
所有患者均接受DAC+CAG诱导治疗，1-2个疗程后，36例（66.7%）达到完全缓解，总有效率为75.9%，中位生存时间为17个月。最常见的突变基因是TET2（33.3%）、CEBPA（31.5%）、DNMT3A（18.5%）、ASXL1（16.7%）、NRAS（14.8%）、RUNX1（14.8%）、FLT3-ITD（12.9%）、TP53（12.9%）、NPM1（12.9%）和IDH2（12.9%）。7例TP53突变患者中，6例在1-2个疗程诱导治疗后获得完全缓解，但对预后的影响无统计学差异。与无FLT3-ITD和NRAS突变的患者相比，有FLT3-ITD和NRAS突变的患者总生存时间较短（P=0.47，P=0.48）。多因素分析显示，FLT3-ITD和NRAS突变是不良预后因素。
老年AML患者中TET2基因突变发生率较高。TET2和TP53突变的AML患者可能从基于地西他滨的化疗中获益。然而，FLT3-ITD和NRAS突变的患者生存时间短，预后可能较差。
