Analysis Of The Biological Characteristics And Prognosis Of Acute Myeloid Leukemia And Myelodysplastic Syndromes With More Than 50% Of Bone Marrow Erythropoietic Cells

Objective: Comparison of biological characteristics of acute myeloid leukemia with one marrow erythroblast and myelodysplastic syndromes.Methods:A total of 121 patients diagnosed as acute erythroleukemia(AEL)at hematology department,union hospital affiliated Fujian medical university from March 2006 to November 2016 were analyzed.17 cases of the 121 cases were transformed from MDS.We categorise them as acute myeloid leukemia(AML)or myelodysplastic syndromes(MDS)according to the new 2016 WHO diagnostic criteria.47 cases were AML,74 cases were MDS.We analyse the general features,the initial blood routine examination,bone marrow cell morphology,dysplastic hematopoiesis of bone,flow cytometry analysis,Karyotype analysis,molecular biology,remission rate after 1 course of chemotherapy,remission rate after 2 courses of chemotherapy,the total remission rate of AML and MDS with t-tes and chi-square test.Kaplan-Meier method was used to analyze two years survival rate and draw survival curves.Results: compare biological characteristics between these two groups.(1)Compare incidence gender and age distribution : two group datum show men are more than women;incidence age of AML group is remarkably lower than that in MDS group(p=0.048).(2)Compare blood routine examination of preliminary diagnosis: leucocyte of preliminary diagnosis and peripheral juvenile cell in AML group is remarkably higher than that in MDS group(P<0.05),other amount of hemoglobin,blood cells and periphery nucleated red blood cell in preliminary diagnosis doesn’t appear remarkably different.(3)Compare bone marrow cell morphology:original bone marrowcell percentage in AML group is higher than that in MDS group(P<0.05),but original bone marrow cell percentage in MDS group is higher than that in AML grou(p=0.001,other marrow megakaryocyte number,marrow lymphocyte percentage doesn’t appear remarkably different.(4)Compare bone marrow hyperplasia degree:the two groups’ degree mainly appeare remarkably active or active and extremely active but minority hypoplasia is decreasing and the two groups’ hypoplasis degree has no statistical significance.The two groups all can see erythoid,granulocyte series and megekaryocyte dyshaematopoiesis.(5)Compare flow cytometry: two groups of erythoid antigen mainly express GLAY and expression rate of MDS group Gly-A(Glycophorin-A)is up to 61.9%,higher than positive expression rate(P=0.002)in AML group(10.53%).Two groups of myeloid antigens mainly express CD13,MPO,HLA-DR,CD117,CD33,CD34,CD15,CD64,part of cases have lymphoid antigen expression like CD7,TDT,CD19,CD20,CD22,and above antigen positive incidence has no statistical significance.Compare chromosomal karyotype analysis: analyze chromosomal karyotype for 30 AML cases.15 cases appear abnormal whose 11 cases are complex karyotype accounting for 36.67 % and involve 6 cases of-7/del(7q)in the abnormal karyotype as well as 4 cases of +8/del(5q)and 4 cases of-5/del(5q);analyze chromosomal karyotype for 47 MDS cases,27 cases appear abnormal and 4 cases doesn’t appear mitotic phase as well as 1 case appears that No.1 chromosome’ secondary constriction prolongs.Among these,there are 8 cases of complex karyotype,accounting for 17.02%,4 cases of involving +8,3 cases of-5/del(5q)and 2 case of-7/del(7q).(7)Molecular biology detection finds that 10 cases of AML group have unfavorable prognosis genes,6 cases containing AXSL1,5 cases containing CEBPA,5 cases containing TET2 gene mutation,1 case containing HOXII,1 case containing dup MLL as well as 1 case containing AML1/ETO1 gene mutation.In MDS group,there are 20 cases of gene mutation including 13 cases of containing ASXL1,10 cases containing TET2,6 cases containing DNMT3,3 cases containing dup MLL,2 cases containing CEBPA,2 cases containing EVI1 gene mutation,2 cases containing positive expression of hemorrhageWT1 and 1 case lacking p53 gene.Comparing the same gene in the different groups is found no statistical significance.And comparing peripheral primitive cell number,primitive cell percentage of marrow and a course of treatment remission rate of 5 cases containing CEBPA gene mutation and 11 cases of patients without CEBPA mutation are notably higher than patients without gene mutation.(8)Compare therapeutic effect evaluation: AML patients have 39 cases of initial induction chemotherapy.Among these,there are 27 cases evaluating therapeutic effect,18 cases reaching CR,15 cases reaching CR through two courses of treatment accounting for 55.56%;MDS patients have 56 cases of initial induction chemotherapy.Among these,there are 38 cases evaluating therapeutic effect,18 cases reaching CR,15 cases reaching CR through two courses of treatment accounting for 39.47%.Comparing remission rate after treating a course of two groups of chemotherapy,AML group remission rate is found to be higher MDS group(0.01).(9)Compare survival rate in two years: comparing survival rate of tow groups in two years,MDS group’ survival rate in two years is found to be higher than AML group(p=0.019).Conclusion:(1)The age of AML group was younger than MDS group.The initial white blood cells 、peripheral immature cells and the percentage of bone marrow progenitor cells in AML group were higher than MDS group.,but the percentage of nucleated red blood cells in group MDS was significantly higher than AML group.(2)The expression rate of Gly-A(glycophorin A)in group MDS was significantly higher than AML group.(3)In AML groups,the number of originality cell in peripheral blood,the percentage of originality cell in bone marrow and the remission rate of 1 course of patients with CEBPA mutation were significantly higher than without mutation.(4)The remission rate of 1 course in AML group was higher than MDS group,but the two year survival rate in MDS group was higher than AML group.