Fusion Gene Detection And Prognosis Analysis Of 163 Patients With De Novo Acute Myeloid Leukemia

Objective: To analyze fusion genes expression in patients with acute myeloid leukemia and the clinical characteristics,efficacy and prognosis in patients with fusion gene expression.Methods: 163 patients with newly diagnosed acute myeloid leukemia(non-M3)were enrolled in our hospital from August 2013 to July 2018 and were detected by 43 fusion genes(including patients with AML transformed from MDS or MPN).Their clinical features and treatment responses were analyzed and compared retrospectively.Overall survival(OS)and Event-free survival(EFS)had been comparatively and statistically analyzed.Results: Among 163 patients with acute myeloid leukemia 49 cases were detected with 9 different fusion genes.28 cases were with AML1-ETO expression,9 cases were CBFβ-MYH11 expression,MLL fusion gene was found in 9 cases.The positive rates of fusion genes of M2,M4 and M5 subtype were respectively 42.4%,25.0% and 32.4%.The positive rate of AML1-ETO was 17.2%,most commonly seen in the M2.Compared with the AML1-ETO(-)group,there is no statistical differences in age,WBC count,immunophenotype and other aspects(P<0.05).The remission rate of the positive expression group was 92.9% within two treatment courses,and that of the negative group was 70.0%,(P=0.012).The survival curves of OS and EFS were statistically different between the two groups(P<0.05).The median total survival time of AML1-ETO(-)was 27.00(17.50-37.49)months,while the median OS was not reached in the positive group,and the median EFS was 16.00(98.94-23.05)months in the negative group,and the median EFS was not reached in AML1-ETO(+)group.CBFβ-MYH11 fusion gene is related to inv(16)and is mostly of M4 subtype.In the M4 subgroup,there was no statistical significance in age,WBC count,platelet count,LDH and other aspects in CBFβ-MYH11(+)compared with CBFβ-MYH11(-).The remission rate of the positive group(100%)was higher than that of the negative group(54.1%)within two courses(P=0.033).There was no statistically significant difference in total survival(OS)between the two groups(P=0.135),but no event survival(EFS)of CBFβ-MYH11(+)was longer(P=0.043).The positive rate of MLL gene rearrangement was 5.5%,including MLL-AF6、MLL-AF9、MLL-AF10、MLL-ELL、MLL-ENL.It was more common in acute monocyte leukemia(M5),and most of them were with 11(q23)abnormalities.The percentage of bone marrow blast cells in the MLL fusion gene positive group was higher(P<0.01),and there was no difference in other clinical features and laboratory indicators.There was no significant difference in the remission rate between the MLL(+)and MLL(-)within two treatment courses.In all patients,there was no statistical difference in OS between the two groups(P=0.204),while the difference in EFS between the two groups was statistically significant(P=0.017).The MLL(-)group had a longer event-free survival.The median EFS time was 10(4.15-15.84)months in the MLL(+),and 20(11.82-28.17)months in the MLL(-).Conclusion: AML1-ETO,MLL fusion genes and CBFβ-MYH11 are common in AML.Fusion gene detection in patients with acute myeloid leukemia can provide an important basis for diagnosis and typing of leukemia.Positive expression of AML1-ETO and CBFβ-MYH11 can be used as a marker of good prognosis of acute myeloid leukemia.MLL fusion genes predict poorer prognosis and chemotherapy effect.Fusion gene assay can be used to evaluate the efficacy and prognosis of patients with acute myeloid leukemia.