Correlative Study Of Telomerase Activity And Subunit Expression In Hyperleukocytic Acute Myeloid Leukemia And Analysis Of Prognostic Factors

Objective:To investigate the relationship between telomerase activity in bone marrow cells of patients with hyperleukocytic acute myeloid leukaemia(HAML)and the number of hyperleukocytes in HAML,and whether telomerase activity and expression of related protein subunits differ among the subtypes of HAML,and to analyze the relationship between telomerase and its subunits and the prognosis of patients with HAML.Methods:42 patients with primary HAML(Non-M3)admitted to the Department of Hematology of Guizhou Provincial People’s Hospital from March 2021 to December2022 were collected,and another 40 cases of non-hyperleukocytic acute myeloid leukemia(NHAML)(Non-M3)(WBC <100×109/L)admitted during the same period were selected as the control group.(some of the specimens were previously collected and stored in the-80°C refrigerator of the Department)The clinical characteristics,telomerase and its subunit levels were compared between the two groups,and the relationship between the clinical characteristics,telomerase and its subunit levels and the prognosis of the patients was analyzed.Results:1.The overall survival rate and 3-year DFS of patients in the HAML group were significantly lower than those in the NHAML group(P < 0.05),and the early mortality rate of patients in the HAML group was significantly higher than that in the NHAML group(P < 0.05);the results of multifactorial analysis showed that age,high leukocyte stasis,WBC,HCT,neutrophil,lymphocyte and LDH levels were independent risk factors affecting the poor prognosis of patients with HAML(P <0.05).2.Telomerase activity was significantly higher in patients in the HAML group than in the NHAML group(P < 0.05),and h TERT m RNA levels,positivity rate and protein positivity rate were significantly higher in patients in the HAML group than in the NHAML group(P < 0.05).3.Telomerase activity was significantly higher in patients with M1 to M2 subtype,M4 to M5 subtype in HAML group and M4 to M5 subtype in NHAML group than in patients with M1 to M2 subtype in NHAML group(P<0.05);telomerase activity was significantly higher in M1 to M2 subtype and M4 to M5 subtype in HAML group than in M4 to M5 subtype in NHAML group(P<0.05);telomerase activity was significantly higher in M4 to M5 subtype in HAML group than in patients with M1 to M2 subtype in NHAML group(P<0.05);telomerase activity was significantly higher in M4 to M5 subtype in HAML group than in patients with M1 to M2 subtype in NHAML group(P<0.05).M5 subtypes were significantly higher than M1-M2 subtypes in the HAML group(P<0.05)。4.The positive rates of h TERT m RNA and protein in patients with M1～M2 subtype and M4～M5 subtype in HAML group and M4～M5 subtype in NHAML group were significantly higher than those in patients with M1～M2 subtype in NHAML group(P<0.05);h TERT m RNA in M1～M2 subtype and M4～M5 subtype in HAML group was significantly higher than that in M4～M5 subtype in NHAML group(P<0.05);h TERT m RNA and protein positivity rates were significantly higher in patients with M4～M5 subtypes in the HAML group than in patients with M1～M2 subtypes(P<0.05).Conclusions:1.High leukocyte stasis,WBC,neutrophils,lymphocytes,LDH levels and coagulation abnormalities are closely related to the occurrence and prognosis of HAML.2.Telomerase activity differed significantly between HAML and NHAML patients,and telomerase activity was highest expressed in M4 to M5 subtypes of HAML patients.3.Telomerase subunit TP1,h TR m RNA level,positivity rate and TP1 protein positivity rate were not differentially expressed among the subtypes in HAML patients.4.The expression of telomerase catalytic subunit h TERT differed significantly between HAML and NHAML patients,and h TERT m RNA and protein positivity were highest in HAML patients with M4 to M5 subtypes.