Clinicalcharacteristics And Prognostic Analyze Of Acutemyeloid Leukemia Cases With EVI1 Gene Positive Expression

Objective:To investigate the clinicalcharacteristics and prognosis of acute myoloid leukimiacases with EVI1 gene positive expression.Methods:309 de novo AML cases hospitalized during 2011-2014 were diagnosed in accordance with MICM criteria. The patients were divided into two groups according to EVI1 gene expression: EVI1 gene positive AML group and EVI1 gene negative group.The induction regimen of non-M3 patient included IA(Idarubicin and cytarabine)regimen(<60 years) and decitabine combined with half amount of CAG(G-CSF 、aclacinomycin and cytarabine) regimen(>60 years). The refractory or relapsed patients were treated with CAG(G-CSF、aclacinomycin and cytarabine) or FLAG(fludarabine 、cytarabine and G-CSF)regimen. Ieter/high-dose cytarabine regimen were used for consolidation therapy. In M3 patient, arsenious acid and ATRA were used for low/intermediate risk patient, while arsenious acid、ATRA combined with Idarubicin were used for high risk patient. The patients who achived complete remission received allo-HSCT when they had the indication for transplantation and were successful in HLA matching. The rest received ieter/high-dose cytarabine for the purpose of consolidation chemotherapy. The clinical features、cytomorphology、cytogenetics、early death、complete remission rate、overall survival 、relapse-free survival and response to allo-HSCT of AML patients with EVI1 gene positive expression were investigated and compared with that in EVI1 gene negative expression group.Results:1.EVI1 gene positive patient(n=35) occurred in 11.3% of patient with de novo AML. Compared with the EVI1 gene negative group, the WBC count in EVI1 gene positive expression AML patients increased notably(P<0.05); otherwise, the percentage of M4/M5 in these patients was much higher according to FAB classification(P<0.05).2. EVI1 gene positive expression was associated with specific recurrent chromosomeabnormalities, including 11q23(MLL gene rearrangement) 、 inv(3)/t(3;3), monosomy 7,while some favorable risk cytogenetics such as t(8;21),t(15;17), and inv(16) were almost exclusive. EVI1 gene positive group with MLL gene positive(20%) is significantly higher than the proportion of the EVI1 gene negative groups with MLL gene positive percentage(4.3%);EVI1 gene positive group with FLT3 gene positive(94.3%) is significantly higher than the proportion of the EVI1 gene negative groups with FLT3 gene positive percentage(5.8%); EVI1 gene positive group with C- KIT gene positive(25.7%) is significantly higher than the proportion of the EVI1 gene negative groups associated with the C- KIT gene positive(2.55%); EVI1 gene positive NPM1 mutations associated with positive percentage(5.9%), significantly lower than the EVI1 negative groups the proportion of positive NPM1 mutations(19%); EVI1 gene positive with AML1- ETO positive(5.7%) is significantly lower than thethe EVI1 negative groups with AML1- ETO positive group(13.1%).3. The AML patients with EVI1 gene positive expression gained lower CR rate compared with EVI1 gene negative group(54.3% vs 74.1%)(P<0.05). Kaplan-Meier analysis showed that both OS and RFS of AML patients with EVI1 gene positive expression were lower than that in EVI1 gene negative group obviously(P<0.05), which indicated an adverse prognosis. Among patients with EVI1 gene positive expression, the cases who received allo-HSCT aquried a higher OS(P<0.05).Conclusions : Compared with EVI1 gene negative expression AML patient, The patient with EVI1 gene positive expression show higher WBC count, associated with poor prognosis factors such as MLL gene positive, FLT3 mutation, C-KIT mutation, etc, poor response to chemotherapy and poor prognosis, and may benefit from HSCT after CR.