| BackgroundAcute myeloid leukemia(AML)is one of malignant clonal diseases along with a wide range of extramedullary infiltration.Patients over age 60,who make up more than 50% of the AML population.With the aging population,the incidence of elderly AML patients is increasing.Elderly AML patients have different biological and clinical features compared to younger patients,and suffer from a worse prognosis,which is derived from oldness,poor tolerance of chemotherapy,poor performance status,more complications and adverse-risk cytogenetics.As is well known,cytogenetic is an important prognosis factor for AML patients.According to the guideline of NCCN,CN-AML was suggested to be intermediate risk group.However,the clinical outcome for elderly CN-AML patients is highly heterogeneous.In old AML patients,about 45-50% patients are normal karyotype(CN-AML).Currently,The clinical treatment and prognosis of elderly CN-AML patients is not clear,therefore,the study of these patients will help to straify them and discuss the individualized treatment ObjectiveWe aimed at analyzing clinical feature and prognostic factors of elderly patients(?60 years old)with cytogenetically normal acute myeloid leukemia(CN-AML)in this retrospective study.Material and MethodsA total of 104 initial elderly CN-AML patients were enrolled in this retrospective study.Among them,one patient was M0,6 patients were M1,45 patents were M2,10 patients were M4,28 patients were M5 and 4 patients were M6.88 patients were primary AML,16 patients were secondary AML(all had prior myelodysplastic syndromes).The clinical characteristics were collected and analyzed retrospectively,which included age,gender,symptoms,comorbidities,regular blood test,cytogenetic change,biological change and the response to therapy.Immunophenotype analysis was carried out by flow cytometry.Specific genetic mutation was examined by using PCR.Chromosome analysis was carried out by using G-banding.CCI score of patients was based on Charlson index.Factors affecting complete remission were analyzed by using chi square test.Univariate and multivariate analysis of prognostic factors were performed by using Kaplan-mier and Cox hazard regression model respectively.A two tail P<0.05 was considered to be significant.Results1.Among 104 elderly patients with cytogenetically normalacute myeloid leukemia,including 60 male patients(57.7%)and 44 female patients(42.3%),the median age was 67 years,The white blood cell(WBC)was 12.50 × 109/L(0-285×109/L),Hemoglobin(Hb)79g/L(35-139 g/L),Platelet count(Plt)36× 109/L(3-397×109/L),Neutrophil count 1×109/L(0-220×109/L),59 cases of bone marrow blasts were over 50%(56.7%),45 cases of bone marrow blasts were less 50%(43.3%).The positive rates of CD34,CD38,CD7,CD19 and CD56 were 47.1%,92.6%,16.8%,4.2%,and 7.4%,respectively.2.The complete remission(CR)rate of 104 patients was 38.9% after first induction chemotherapy and total response rate was 55.6%.In patients had lower white cell count<100×109/L(p=0.02)and NPM1 mutation(?2=6.876,p=0.009)were related to a higher CR rate.3.Among 104 patients,the mean overall survival(OS)was 12.5 months and the median OS was 6.9 months.Univariate analysis results demonstrated that age?70 years,secondary AML,white cell count(?100×109/L),FLT3-ITD mutation,CD7 expression,Achieving CR beyond 2 cycles of induction and CCI score?2 had poor influence on OS.In multivariable analysis,FLT3-ITD mutation(HR:7.61,95%CI:1.80~32.11,p=0.006)and achieving CR beyond 2 cycles of induction(HR: 10.11,95%CI: 2.38~43.03,p=0.002)were independent prognostic factors for older patients with cytogenetically normal AML and were associated with lower OS.Conclusion1.The clinical festures of elderly patients of CN-AML including fever?anemia?hemorrhage and lymphadenectasis?hepatolienomegaly?sternodynia2.Many factors have effect on the prognosis of elderly patients of CN-AML.FLT3-ITD mutation and achieving CR beyond 2 cycles of induction are independent prognostic factors for elderly patients with CN-AML. |
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