Antigen Expression And Clinical Efficacy Of Non-APL Acute Myeloid Leukemia

Purpose:By analyzing the antigen expression characteristics and clinical remission rate of 148cases of non-APL acute myeloid leukemia,the relationship between antigen differential expression and therapeutic effect was discussed,and the difference of therapeutic effect between different induction chemotherapy schemes for CD123+AML patients was discussed.Method:1.Participants:148 cases of newly diagnosed acute myeloid leukemia(AML)admitted to the Department of Hematology and Immunology,Affiliated Hospital of Yan'an University from January 2014 to January 2019 were collected.The patients with AML with abnormal karyotype and molecular biology were excluded,and the patients with acute promyelocyte(APL)were excluded.2.Contents of the study:148 newly treated AML patients were examined by bone marrow cell morphology,cytochemical staining,bone marrow pathology,leukemia immunotyping,chromosome karyotype and FISH detection to analyze the characteristics of antigen expression in FAB typing,to observe the complete remission(CR)rate of AML patients after chemotherapy with two induction schemes,and to compare the CR rates of different antigen-positive and negative expression groups,and to analyze the CR rates.The relationship between antigen differential expression and curative effect;the risk factors affecting curative effect were analyzed by logistic regression;the difference of curative effect between different routine induction chemotherapy regimens(DA,MA and IDA)in CD123+AML patients was compared;and the difference of curative effect between the routine induction chemotherapy regimen and the dicitabine+CAG regimen in CD123+AML patients was compared.SPSS 20.0 software is used for data processing.Result:1.Case information:Among 148 AML patients,M2 and M4 subtypes were the most common,with 50cases each,followed by M5(30 cases),M1(14 cases),M0(2 cases),M6 and M7(1 case each).There were 68 female patients(46%)and 80 male patients(54%).The age range was 12-82 years,with a median age of 47 years.112 cases(76%)of AML were younger than 60 years old and 36 cases(24%)were younger than 60 years old.After two courses of standard treatment and standard dose chemotherapy,89 patients(60.1%)received CR,21 patients(14.2%)received PR and 38 patients(25.7%)received NR.2.Characteristics of antigen expressionThe positive rates of CD13,CD117 and CD33 in myeloid antigens of 148 AML patients(except APL)were higher than those of other types,and the positive rates of CD64 and CD14 in M4 and M5 were higher than those of other types.The positive rates of non-specific antigens were CD38(75.6%),HLA-DR(70.9%),CD34(58.7%)and CD123(67.6%)respectively.Among 148 patients,41 had gonorrhea antigen expression,and the positive rates were CD7(21.6%),CD19(5.4%)and CD20(0.6%).The proportion of white blood cells and bone marrow primordial cells in patients with CD123+AML(except APL)at first diagnosis was higher than that in patients with CD123-and the difference was statistically significant.3.Clinical efficacy analysis3.1 Relationship between age,gender and curative effectIn 148 AML patients,there was no significant difference in CR rate between male and female patients.The CR rate of patients over 60 years old was significantly lower than that of patients under 60 years old,and the difference was statistically significant.3.2 The relationship between blood routine,bone marrow primordial cell ratio and curative effectBlood routine and curative effect of AML patients at first diagnosis:CR rate of WBC?50×10~9/L group was lower than WBC<50×10~9/L group,the difference was statistically significant between the two groups;CR rate of HB>90 g/L group and HB<90 g/L group,PLT?20×10~9/L group and PLT<20×10~9/L group had differences,but there was no significant difference.Ratio and efficacy of bone marrow primordial cells in AML patients at first diagnosis:CR rate of group with bone marrow primordial cells ratio>70%was lower than that of group<70%with statistical significance.3.3 Relationship between Immunotyping and Therapeutic EffectThe CR rates of CD117,CD123,CD7 and CD34 positive groups were significantly lower than those of negative groups,and the difference between the two groups was statistically significant.The CR rate of CD38 positive group was significantly higher than that of CD38 negative group,and the difference between the two groups was statistically significant.Antigen co-expression and efficacy:The CR rate of CD123+/CD34+group was lower than that of CD123+/CD34-group,and the difference was statistically significant.The CR rate of CD123+/CD7+group was significantly lower than that of CD123+/CD7-group,and the difference was statistically significant.Through single factor and multivariate logistic regression analysis,CD123,CD34 and CD7 were the risk factors affecting the efficacy of AML.3.4 Comparison of the efficacy of different induction chemotherapy regimens in CD123 positive patientsAmong 97 AML patients with CD123 positive,79 patients were treated with conventional(3+7)induction chemotherapy.The CR rates of each regimen were DA(45.5%),MA(35.3%)and IDA(52.2%).There was no The ORR and CR rates of CD123+group were 88.9%and 72.2%,respectively.The ORR and CR rates of conventional(3+7)group were 60.8%and 48.0%,respectively.The ORR and CR rates of dicitabine+CAG group were significant higher than those of conventional(3+7)group,and the difference was statistically significant.conclusion1.CD13,CD117 and CD33 are sensitive indicators for the diagnosis of AML;CD14and CD64 are helpful for the identification of M4,M5 and other types,which are consistent with the results of domestic and foreign studies.The high proportion of white blood cells and bone marrow primordial cells in CD123 positive patients at first diagnosis suggests that the tumor burden is heavy.2.The positive expression of CD123,CD34,CD117 and CD7 was negatively correlated with the efficacy of AML,and the efficacy of patients with co-expression of CD123/CD34 and CD123/CD7 was worse than that of patients with single antigen expression.Positive expression of CD123,CD34 and CD7 is a risk factor for the efficacy of AML.3.The CR rate of patients with CD123 positive using DXB+CAG regimen is higher than that of conventional induction chemotherapy regimen(3+7).The results of this study have important guiding significance for the selection of induction chemotherapy regimen for patients with CD123 positive AML.