Qin Han, Xu Rui, Yang Yingchao
Department of Blood Transfusion, Dalian Third People's Hospital, Dalian, Liaoning Province, China.
Department of Transfusion, Peking University Third Hospital, Beijing, China.
Medicine (Baltimore). 2024 Dec 6;103(49):e40565. doi: 10.1097/MD.0000000000040565.
Isocitrate dehydrogenase (IDH) gene alterations and acute myeloid leukemia (AML) treatment results remain controversial. This study reviews the literature on IDH mutations in AML to determine the foundation of individualized therapy and improve effectiveness, survival time, and recurrence rate.
Seven English and 2 Chinese databases were searched for literature on IDH mutations and AML outcomes. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated.
Twenty studies were included in this analysis. For the prognostic influence of IDH mutation on AML patients, the pooled HRs of overall survival in AML patients were 0.76 (95% CI, 0.63-0.93); the pooled HRs of event-free survival were 1.34 (95% CI, 1.15-1.57; heterogeneity: I2 = 52.2%, P = .027 < 0.05); the pooled HRs of recurrence free survival were 0.79 (95% CI, 0.61-1.02). The pooled HRs of overall survival in AML patients with mutant IDH1 were 1.62 (95% CI, 1.42-1.86) and of mutant IDH2 were 1.07 (95% CI, 0.89-1.29). The pooled HRs for event-free survival in AML patients with mutant IDH1 were 1.71 (95% CI, 1.40-2.08) and of mutant IDH2 were 0.93 (95% CI, 0.65-1.34). No evidence of publication bias was observed.
Different subtypes of IDH mutations may lead to different AML prognoses, suggesting the feasibility of personalized treatment for AML patients.
异柠檬酸脱氢酶（IDH）基因改变与急性髓系白血病（AML）的治疗结果仍存在争议。本研究回顾了关于AML中IDH突变的文献，以确定个体化治疗的基础，并提高疗效、生存时间和复发率。
检索了7个英文数据库和2个中文数据库，以获取有关IDH突变和AML预后的文献。计算合并风险比（HR）和95%置信区间（CI）。
本分析纳入了20项研究。对于IDH突变对AML患者的预后影响，AML患者总生存的合并HR为0.76（95%CI，0.63 - 0.93）；无事件生存的合并HR为1.34（95%CI，1.15 - 1.57；异质性：I2 = 52.2%，P = 0.027 < 0.05）；无复发生存的合并HR为0.79（95%CI，0.61 - 1.02）。IDH1突变的AML患者总生存的合并HR为1.62（95%CI，1.42 - 1.86），IDH2突变的为1.07（95%CI，0.89 - 1.29）。IDH1突变的AML患者无事件生存的合并HR为1.71（95%CI，1.40 - 2.08），IDH2突变的为0.93（95%CI，0.65 - 1.34）。未观察到发表偏倚的证据。
IDH突变的不同亚型可能导致不同的AML预后，提示AML患者个体化治疗的可行性。
