Clinical Analysis Of Cytogenetics And Molecularbiology Features Of 395 Patients With AML

The acute myeloid leukemia is a specific kind of disease which is different from morphology, cytogenetics, immunochemistry and molecularbiology,and the clinical character also has some remarkable difference. In recent years, along with the development of cytogenetics and molecularbiology, people have much more thorough understanding of the mechanism of cytogenetics and molecular markers. And it is sure that there is a relationship between the cytogenetics and molecularbiology and prognosis.Purpose:Analyzing the incidence of subtype M0-M7 and that of the abnormality of cytogenetics and molecular markers in our department .Acquiring the relationship between cytogenetics and molecular markers and prognosis .Method:Selecting the 395 AML patients who have been diagnosed for the first time from January 1, 2006 to October 1, 2010 in our department. Applying statistics method to study the incidence of AML and the abnormality of chromosome and molecular markers.Also to learn the relationship between cytogenetics and molecular markers and prognosis .There are 215 males and 180 females who are aging from 2 to 82,with the medium of 45 years old.Result:(1)According to the standard of FAB subtype, M2 is the most common subtype in our department,the incidence reaches to 46.58%. The next is M3 ,which reaches to 34.43%.No matter which type ,including M2 or M3, patients who suffered from AML are common among 40-49 years old.(2)In this research, the incidence of abnormality of chromosome is 74.51%, and the t(15;17) is the most, reaching to 31.65%.Then is the t(8;21), about 18.49%. Inv(16), -5, -7, +8, -Y, 11q23abn and complicated karyotype are seldom.Almost all the t(15;17) are found in M3, and the t(8;21) is seen in 87.88% of M2 patients, and the rest is seen in M4(9.09%), M5(3.03%).But 34% of M2 patients have t(8;21), whereas 30% of that are normal ,11% have the -Y chromosome, 9% have complicated chromosome karyotype, the rest is seen in -5, -7, +8 and other abnormality karyotypes.Complicated karyotype can be found in each age group and each FAB subtype , M2 is common. (3)Referring to prognosis,97.12% of the patients with t(15;17) reach CR after inducing treatment.(There are only 3 ones of all the 104 patients dying from severe complications. One is apoplexy ,another is DIC,the last case is severe lung infection.Almost all the rest of 101 patients reach 1stCR.) And 72.34% of patients with t(8;21) reach CR after inducing treatment. There are 23 patients of all the 25 ones who have simple t(8;21) without other abnormalities reach 1stCR,and the rate is 92%.Other 22 patients have t(8;21) with other abnormalities (15 ones with–Y,4 with +8,another 3 with complicated karyotype) ,the rate of 1stCR is 50%.And the CR rate of the normal karyotype is 61.90%,that of -Y karyotype is 58.82%,and that of complicated karyotype is 16.67%. (4) In our research ,the examination of PML/RARαand AML1/ETO gene enhanced sensibility of cytogenetics of AML , and raised accuracy of diagnosis .The increased rate are 7.41% and 10.14% respectively.For another thing,NPM1, FLT3-ITD and c-KIT are all the common mutations of molecular markers.In this research,7.69% of patients are NPM1 positive,and rate of positive FLT3-ITD is 3.90%, c-Kit is 37.5%.Five cases with positive c-Kit of all the six patients are see in M2,and two patients have t(8;21)(q22;q22),another two with +8. Because the number of case is too small,so the relationship between abnormality of molecular markers and prognosis is still unclear.Conclusion:(1) In this research,M2 is the most common subtype in our department. M3 is following. (2) The incidence of t(15;17) is the highest, which is almost found in M3.Referring to prognosis, t(15;17) is one of the favourate group.(3) t(8;21) is also the favourate karyotype.But its prognosis is not usually very good because of the existenc of the abnormality of additional chromosome.For example,its 1stCR rate is affected. (4) Molecularbiology analysis:the examination of molecularbiology enhances the sensibility of that of cytogenetics in AML ,and also raises accuracy of diagnosis.In our research, c-Kit is common found in M2 , and always happens with the abnormality of t(8;21)(q22;q22) .