The Exploration Of Prognostic Scoring Systems In Chinese Adult Acute Myeloid Leukemia Patients

[Objective]Acute myeloid leukemia?AML?is a heterogenous malignance characterized by the dismal outcome.For better outcome,it is necessary to develop individual therapy according to the risk stratification.In this study,a retrospective clinical study was conducted to explore the prognostic scoring system of Chinese adult AML patients.[Methods]This study retrospectively collected adult AML patients who were hospitalized and diagnosed in Wuhan union hospital,and relevant clinical data,and laboratory examination were recorded.Overall survival?OS?and relapse-free survival?RFS?were calculated as the main prognostic indicators.Patients were stratified by the Chinese diagnosis and treatment guide of AML?2017?,the European Leukemia Network?ELN?recommendations of AML?2017?,and the NCCN Clinical Practice Guidelines in acute myeloid leukemia?2018 version I?.Patients'clinical data?age,AML type?de novo/secondary?,LDH,ECOG score?,cytogenetics and gene mutations were analyzed,and a Cox proportional risk model was applied to establish a comprehensive prognostic scoring system?CPSS?for OS and RFS,respectively.Survival curves were used to compare the prognostic value of the four risk prognostic systems.[Results]A total of 216 patients with AML who were hospitalized at Wuhan union hospital between April 2011 and April 2018 were collected,170 of whom received at least one induction chemotherapy and 120 of whom achieved complete remission?CR?.105 patients detected gene mutations by next-generation sequencing.CEBPA,IDH2,NPM1,TET2,DNMT3A,FLT3-ITD,and ASXL1 were gene mutations occurred in more than 10%of the patients.According to CPSS_OS,170 patients receiving treatment were divided into three groups,the low-risk group was 25.9%with 1-year OS rate 100.0%,the intermediate-risk group was 50.6%with 1-year OS rate 82.9%,the high-risk group was 23.5%with 1-year OS rate 38.2%?p<0.0001?.According to CPSS_RFS,we divided 120 patients who achieved CR into three groups:the low-risk group was 31.7%with 1-year RFS rate 87.7%,the intermediate-risk group was 47.5%with 1-year RFS rate 58.4%,the high-risk group was20.8%with 1-year RFS rate 30.2%?p<0.0001?.Compared with the patients with negative chromatin-spliceosome mutations?SF3B1,U2AF1,SRSF2,ZRSR2,EZH2,BCOR,and STAG2?,patients with positive chromatin-spliceosome mutations had shorter OS and RFS?p<0.0001?.[Conclusions]CPSS is a quantified prognostic score system,which takes into account the influence of clinical factors,cytogenetics and gene mutations,we conclude that the CPSS could improve the stratification of AML patients.