Analysis Of Clinical Characteristics And Prognosis Of 270adults(≤60 Years Old)with De Novo Acute Myeloid Leukemia

BackgroundAcute myeloid leukemia(AML)is a heterogeneous clonal hematopoietic stem cell disease,which is the most common acute leukemia in adults.With the development of flow cytometry,chromosome karyotype analysis and gene diagnosis,MICM typing is used for clinical diagnosis.Similarly,great efforts and progress have been achieved in the field of the treatment of AML,including the curable modality such as allogeneic hematopoietic stem cell transplantation(allo-HSCT),several novel agents as inhibitors targeting BCL-2,IDH1/2 and FLT3,hypomethylation agents.However,the high degree of heterogeneity in patients with AML still poses challenges to treatment,including not only disease-related features such as cytogenetic and molecular abnormalities,but also individual factors,including age and physical condition.As a result,the prognosis of patients with AML is unsatisfactory,and more than half of the patients eventually die of the disease.ObjectiveWe aim to understand the complex interactions of disease-related and patient-related factors,including clinical characteristics,laboratory results,and choice of treatment regimens.And explore the factors that affect the early efficacy and prognosis of AML patients.MethodsClinical data of 270 adult(≤60 years old)patients with de novo AML were collected and screened from January 2015 to December 2019 in the Department of Hematology,Affiliated Cancer Hospital of Zhengzhou University.All patients were confirmed by morphology,immunophenotype,cytogenetics and molecular biology(MICM).And then the treatment regimens of the patients were collected and the efficacy of different treatment regimens was analyzed,and followed up the prognosis.SPSS 21.0 software package was used for data processing,and Graph Pad Prism8software was used for drawing.Results1.Clinical characteristics:270 patients,median age of onset was 45 years old;the male-to-female ratio was 1.2:1;the median WBC was 14.13×10~9/L,PLT38×10~9/L,HGB 77g/L,and the ratio of bone marrow blasts 0.580;there were 40cases of hyperleucocyte(14.8%),51 cases of severe anemia(18.9%),52 cases of severe platelet reduction(19.3%).2.Cytogenetic:the detection rate of abnormal karyotype was 41.8%.t(8;21)(q22;q22)with or without other karyotype abnormalities were 41 cases(17.3%),t(8;21)(q22;q22)abnormalities were observed in 22 cases(9.3%),3 cases(1.3%)with-X abnormalities and 10 cases(4.2%)with-Y abnormalities;+8abnormalities were found in 10 cases(4.2%).ELN risk stratification:100 cases(37.0%)in the low-risk group,117 cases(43.3%)in the intermediate-risk group,and53 cases(19.6%)in the high-risk group.3.Fusion gene:the positive detection rate was 36.4%.The most common cases were AML1-ETO in 56 cases(23.7%),CBFB-MYH11 in 14 cases(5.9%)and MLL-(AF6、AF10、AF17、ELL、ENL)in 6 cases(2.5%).4.Gene mutation:The mutation rate was 77.5%.The most common cases were FLT3-ITD 52 cases(23.3%),TET2 50 cases(21.2%)and NPM1 41 cases(17.4%).5.The relationship between disease characteristics and age:with the increase of age,the WBC,HGB,PLT and bone marrow blasts at the time of initial diagnosis did not change significantly(P>0.05).Patients aged 18 to 40 years and 41 to 65 years accounted for 43.7%and 56.3%,respectively.The incidence of positive AML1-ETO fusion gene was higher in the 18-40 years group(P=0.001),and the incidence of positive FLT3-ITD mutation、NPM1 positive and negative FLT3-ITD was higher in the 41-60 years group(P=0.025).6.Effectives of early induction chemotherapy:270 patients,196 patients(72.6%)obtained CR after 1 course of chemotherapy,234 patients(86.7%)obtained CR after≤2 courses of chemotherapy,and 244 patients(90.4%)obtained finally CR.Single factor:age,ELN risk stratification,AML1-ETO gene status,and different induction regimens(scalar/low dose)were associated with CR rate.Multivariate:The high-risk group in the ELN risk stratification was an independent disadvantage for CR.7.Infection characteristics:the incidence of primary induced infection was69.6%.The most common site:pulmonary infection(45.9%);The most common pathogens were gram-negative bacteria(41 strains,50.6%).8.Relapse and survival:The 3-year RFS and OS rates were 59.0%and 61.8%in244 patients who finally obtained CR.Univariate analysis:Hyperleukaemia,AML1-ETO gene status,different risk stratification of ELN,remission within less than 2 courses were the factors affecting RFS and OS,and positive FLT3-ITD mutation was the adverse factor for RFS.Multivariate analysis:The high-risk group was an independent risk factor for RFS.Positive AML1-ETO fusion gene was an independent favorable factor affecting RFS and OS.9.Transplantation and chemotherapy:There was no difference in OS and RFS between the transplantation group and the chemotherapy group in the overall population.Subgroup analysis:Transplantation recipients had better OS and RFS compared to chemotherapy in the intermediate-risk and high-risk group.In the hyperleukaemia group,transplantation recipients also had better OS and RFS compared with chemotherapy regimens.Conclusion1.There are more male patients with acute myeloid leukemia in our hospital,and the number of WBC at the onset is higher than the normal,accompanied by anemia and thrombocytopenia.Chromosome karyotype analysis showed that more than half of them were normal karyotypes.The highest incidence of gene mutation was FLT3-ITD.The risk stratification of prognosis was mainly intermediate risk and favorable risk.2.There were differences in the distribution of molecular biological characteristics of patients aged between 18 to 40 years and 41 to 65 years,the former was dominated by AML1-ETO fusion genes,while the latter was dominated by gene mutations with FLT3-ITD,while there were no differences in the WBC,HGB,PLT and bone marrow blasts at initial diagnosis between the two groups.3.In ELN risk stratification,the adverse risk group was an independent adverse factor affecting CR and RFS,and patients with positive AML1-ETO fusion gene could obtain better OS and RFS.Patients with hyperleukaemia at the time of initial diagnosis and those with intermediate or adverse risk could benefit from transplantation.