Analysis Of Chromosome Karyotype And Prognosis Study In Patients With Ph~+ Chronic Myeloid Leukemia

Objective To analyze the distribution characteristics of chromosome karyotypes in bone marrow cells of patients with Ph~+chronic myeloid leukemia(CML)at different stages,and to explore the correlation between different types of chromosome karyotypes and disease prognosis.Methods 351 patients diagnosed as Ph~+CML in the Affiliated Hospital of Qingdao University from January 2009 to January 2019 were selected as the research objects,and a retrospective study was conducted.There were 317 cases in chronic phase,12 cases in accelerated phase,22 cases were in blastic crisis phase.Bone marrow chromosome culture and chromosome was performed several times during diagnosis and treatment,chromosome analysis was performed by R-banding technique,Kaplan-Meier method was used to analyze the difference of overall survival(OS)of patients with different karyotype.Results Among 351 cases of Ph~+CML,272 cases were typical translocation,of which258 cases were in chronic phase,7 cases were in accelerated phase,and 7 cases were in blastic crisis.32 cases were variant translocations,30 cases were in chronic stage,and 2cases were in accelerated phase,accounting for 9.46%and 16.66%of all patients in chronic stage and accelerated phase.Among them,there were 22 cases of simple variation translocation(68.75%,22/32)and 10 cases of complex variation translocation(31.25%,10/32),involving multiple chromosomes 1,2,3,4,5,6,7,10,11,12,14,17,19,21 and22,and 7p22(12.5%)had the highest cumulative frequency.There was no significant difference between simple variant translocation,complex variant translocation and typical translocation in disease stage(P>0.05).47 cases of additional chromosomal abnormalities at initial diagnosis,including 29 cases of chronic phase,accounting for9.1%of all the patients in CML chronic phase;3 cases in accelerated phase,25%of all the patients in the accelerated phase,15 in the blastic crisis(68.1%).Among 47 patients with Ph~+CML with additional chromosomal abnormalities,13 patients had complex karyotypes with more than 3 chromosome abnormalities,the proportion of complex karyotypes in chronic phase,accelerated phase and blastic crisis were 13.79%(4/29),33.33%(1/3)and 53.33%(8/15).the accelerated phase and the blastic crisis phase has significantly higher proportion of complex karyotypes than that in the chronic phase(χ~2=9.26,P<0.05).The study showed that the most common chromosomal abnormalites in chronic phase were double Ph(48.28%,14/29)and-Y(10.34%,3/29),while the most common chromosomal abnormalities in the blastic crisis were+8(26.67%,4/15)and double Ph(26.67%,4/15).The accelerated phase and the blastic crisis phase of Ph~+CML have significantly higher additional chromosomal abnormalities proportion than that in the chronic phase(χ~2=50.799,P<0.05).From Kaplan-Meier survival function analysis,we can see the prognosis of the variant translocation group was basically the same as that of the typical translocation group(χ~2=0.911,P>0.05);the OS time of the patients with Ph~+additional chromosomal abnormalites was significantly shorter than that of patients with only Ph translocation,there was a significant difference in prognosis between them(χ~2=61.138,P<0.05);the OS time of patients with complex karyotypes was shorter than other additional chromosome patients with Ph~+(χ~2=4.945,P<0.05).Of the 273 patients with only Ph translocation,9 patients in the chronic phase has additional chromosomal abnormalities during the course of treatment,by the end of follow-up,3 cases(33.33%,3/9)died,1 cases(11.11%,1/9)was in the accelerated phase,3 cases were still in the chronic phase,and only 2 patients(22.22%,2/9)were in remission.Conclusion 1.There was no statistical difference between the distribution of typical Ph~+chromosome,simple variant translocation and complex variant translocation in the patients with Ph~+CML.There was no significant difference between variant translocation and typical translocation in the prognosis of CML.2.The prognosis of CML with additional chromosomal abnormalities is significantly worse than that of patients with only Ph translocation.Moreover,the more complex the additional chromosomes are,the greater the possibility of blastic changes and the worse of prognosis.3.The presence of additional chromosomal abnormalities in CML patients may be closely related to the progression of the disease,and abnormalities of additional chromosomes during the treatment of CML patients may also lead to the progression of the disease.