Zhao Mingyue, Liao Mingyue, Gale Robert Peter, Zhang Meijie, Wu Lixin, Yan Nan, Liu Lixia, Qin Jiayue, Cao Shanbo, Chang Yingjun, Jiang Qian, Xu Lanping, Zhang Xiaohui, Huang Xiaojun, Jiang Hao, Ruan Guorui
Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University Institute of Hematology, Peking University People's Hospital, Beijing 100044, China.
Centre for Haematology, Department of Immunology and Inflammation, Imperial College of Science, Technology and Medicine, London SW7 2AZ, UK.
Biomedicines. 2024 Dec 23;12(12):2921. doi: 10.3390/biomedicines12122921.
: About half of adults with acute myeloid leukemia with normal cytogenetics (CN-AML) have mutations. There is controversy regarding their prognosis and best therapy. : We studied 150 subjects with these features using targeted regional sequencing. Prognostic stratification was carried out based on risk factors, and we assessed the effects of two post-remission strategies with and without transplant across risk cohorts. : In multi-variable analyses, a positive MRD test after the second consolidation cycle (HR = 6.00; 95% CI [3.31, 10.85]; < 0.001), mutations (HR = 3.01 [1.57, 5.78]; < 0.001), -ITD mutation with high variant allele frequency (HR = 4.40 [1.89, 10.24]; < 0.001) and mutations (HR = 4.38 [2.38, 8.04]; < 0.001) were independently correlated with higher cumulative incidence of relapse (CIR) and worse leukemia-free survival (LFS) (HR = 5.49 [3.01, 10.04]; 0.001; HR = 2.99 [1.60, 5.62]; 0.001; HR = 4.20 [1.87, 9.40]; 0.001; and HR = 4.22, 95% CI [1.99, 8.95], 0.001). Subjects with ≥1 high-risk co-variate who received a transplant had a lower CIR and better LFS, whereas others did not. : We identified co-variates associated with CIR and LFS in subjects of -mutated CN-AML.
约半数细胞遗传学正常的急性髓系白血病（CN-AML）成年患者存在基因突变。关于其预后及最佳治疗方法存在争议。我们使用靶向区域测序研究了150例具有这些特征的受试者。基于风险因素进行预后分层，并评估了有或无移植的两种缓解后策略对不同风险队列的影响。在多变量分析中，第二次巩固周期后微小残留病（MRD）检测呈阳性（风险比[HR]=6.00；95%置信区间[CI][3.31,10.85]；P<0.001）、基因突变（HR=3.01[1.57,5.78]；P<0.001）、高变异等位基因频率的NPM1-内部串联重复（ITD）突变（HR=4.40[1.89,10.24]；P<0.001）以及FLT3基因突变（HR=4.38[2.38,8.04]；P<0.001）均与更高的累积复发率（CIR）和更差的无白血病生存期（LFS）独立相关（HR=5.49[3.01,10.04]；P<0.001；HR=2.99[1.60,5.62]；P<0.001；HR=4.20[1.87,9.40]；P<0.001；以及HR=4.22，95%CI[1.99,8.95]，P<0.001）。具有≥1个高危协变量且接受移植的受试者CIR较低，LFS较好，而其他受试者则不然。我们在NPM1基因突变的CN-AML受试者中确定了与CIR和LFS相关的协变量。
