Clinical Characteristics And Prognosis Of Children With Normal Karyotype Acute Myeloid Leukemia

Background and Aims: To explore the clinical characteristics and prognosis of children with normal karyotype acute myeloid leukemia(CN-AML),compare the characteristics of non-CN-AML group with the exception of acute promyelocytic leukemia(APL)in the same period in single center,and to provide evidence for further improvement of diagnosis and treatment of childhood AML.Methods:A retrospective analysis of 151 cases newly diagnosed children with AML(non APL)in the Department of Hematology of Children's Hospital Affiliated to Suzhou University from October 2010 to October 2016 was achieved.Classical chemotherapy regimen or similar chemotherapy regimen were used as the induction procedures.The patients were divided into the CN-AML group and the non-CN-AML group.t-test and analysis of variance(ANOVA)were used to analyze the clinical parameters before treatment,including gender,age,blood routine(including white blood cells,platelet,hemoglobin),ferritin,lactate dehydrogenase(LDH),cerebrospinal fluid and bone marrow naive cells ratio,immunophenotype,chromosomal changes and molecular biology abnormalities;Chi square analysis was used to analyze whether the difference of complete remission(CR)rate between different groups was significant;The Kaplan-Meier survival was used to assess the 3-year overall survival(OS)and disease-free survival(DFS)in each group.The significant difference of survival between groups was compared by Log-Rank test.Univariate and multivariate prognostic indexes were analyzed by binary logistic analysis.Results:(1)The median follow-up time of 151 patients was 30 months.The complete remission(CR)rate of 1 courses of treatment was 70.9%.The complete remission(CR)rate of 2 courses of treatment(the total CR rate)was 94.1%.The 1-year OS and DFS rates were(80.1±3.5)% and(79.1±3.6)%,respectively.The 3-year OS and DFS rates were(73±4.8)% and(59.9±5.8)%,respectively.(2)According to the international prognostic group,44 cases of the CN-AML children were divided into the middle-risk group and the high-risk group.The 3-year OS rates were(69.0±12.4)%,(66.7±12.2)%,P=0.647>0.05,respectively.The difference was not statistically significant.The 3-year DFS rates were(59.1±14)%,(51.9±13.2)%,P=0.467>0.05,there was no significant difference between them.(3)Grouped according to international prognosis,107 cases of the non CN-AM L patients were divided into the low risk group,medium risk group and high risk group.The 3-year OS rates were(87.3±6.9)%,(80.5±7.7)%,(56±14.1)%,P=0.092>0.05,respectively,with no significant difference.The 3-year DFS rates were(77.6±11.0)%,(55.1±12.5)%,(52.3±13.7)%,P=0.226>0.05,respectively,with no significant dif ference.(4)The CN-AML group compared with the non CN-AML group: The 3-year OS rates were(68.8±8.4)% and(73.7±6.3)%,respectively,P=0.407>0.05.The 3-year DFS rates were(56.5±9.5)% and(59.4±7.8)%,respectively,P=0.384>0.05.Both groups P were greater than 0.05,no significant difference.(5)Compared with the CN-AML group and the CBF(without C-kit mutation)subgroup in non-CN-AML: The 3-year OS rates were(68.8±8.4)%,(80.1±11.5)%,P=0.041<0.05.The 3-year DFS rates were(56.5±9.5)%,(74.8±11.9)%,P=0.02<0.05.Both P values were less than 0.05,with significant differences.Compared with the CN-AML group and the CBF(with C-kit mutation)subgroup in non-CN-AML: The 3-year OS rates were(68.8±8.4)%,(84.4±8.3)%,P=0.309>0.05.The 3-year DFS rates were(56.5±9.5)% and(56.3±23.6)%,respectively,P=0.322>0.05.There was no significant difference between the two groups.Compared with the CN-AML group and the MLL gene subgroup in non-CN-AML,the 3-year OS rates were(68.8±8.4)% and(52.4±12)%,respectively,P=0.175>0.05.The 3-year DFS rates were(56.5±9.5)%,(46.6±12)%,P=0.301>0.05.The difference was not statistically significant.(6)Univariate analysis of CN-AML prognosis showed that the risk grouping,the expression of CD117 and CD34,peripheral blood white blood cell count at the beginning of diagnosis,ratio of primordial cells,D dimer number,and whether to get remission after two courses of induction chemotherapy,were the adverse factors affecting the prognosis of children.(7)Multivariate analysis of CN-AML prognosis showed that peripheral blood white blood cell count,D dimer value and whether to get remission after two courses of induction chemotherapy were the risk factors influencing the prognosis of children.Conclusions:(1)Multivariate analysis showed that,peripheral blood white blood cell count,D dimer number and whether to get remission after two courses of induction chemotherapy were the risk factors for the prognosis of children with CN-AML.(2)There was no significant difference in 3-year OS and DFS between the CN-AML group and the non-CN-AML group.(3)The comparative analysis of prognosis of the CN-AML group and the MLL gene subgroup,the CBF(without C-kit mutation)subgroup and the CBF(with C-kit mutation)subgroup in non-CN-AML showed that: There was no significant difference in 3-year OS and DFS between the CN-AML group,the MLL gene subgroup and the CBF(with C-kit mutation)subgroup,while the 3-year OS and DFS of the CBF(without C-kit mutation)subgroup in non-CN-AML were significantly better than that of the CN-AML group.