[1]纪婷婷,陶善东,丁邦和,等.非M3型急性髓系白血病患者骨髓原始细胞酪氨酸蛋白激酶CD117的表达及意义[J].新乡医学院学报,2024,(4):353-357.[doi:10.7683/xxyxyxb.2024.04.010]
　JI Tingting,TAO Shandong,DING Banghe,et al.Expression of tyrosine protein kinase CD117 in patients with non-M3 acute myeloid leukemia and its significance[J].Journal of Xinxiang Medical University,2024,(4):353-357.[doi:10.7683/xxyxyxb.2024.04.010]
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非M3型急性髓系白血病患者骨髓原始细胞酪氨酸蛋白激酶CD117的表达及意义
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
期数:
2024年4
页码:
353-357
栏目:
临床研究
出版日期:
2024-04-05

文章信息/Info

Title:
Expression of tyrosine protein kinase CD117 in patients with non-M3 acute myeloid leukemia and its significance
作者:
纪婷婷1; 2; 陶善东1; 2; 丁邦和1; 2; 王春玲1; 2; 于亮1; 2
（1.南京医科大学附属淮安第一医院血液科，江苏　淮安　223300;2.南京医科大学血液病重点实验室,江苏　南京　210009）
Author(s):
JI Tingting1; 2; TAO Shandong1; 2; DING Banghe1; 2; WANG Chunling1; 2; YU Liang1; 2
(1.Department of Hematology,the Affiliated Huai′an No.1 People′s Hospital of Nanjing Medical University,Huai′an 223300,Jiangsu Province,China;2.Key Laboratory of Hematology,Nanjing Medical University,Nanjing 210009,Jiangsu Province,China)
关键词:
急性髓系白血病; 免疫表型; CD117; 预后
Keywords:
acute myeloid leukemia; immunophenotype; CD117; prognosis
分类号:
R733.71
DOI:
10.7683/xxyxyxb.2024.04.010
文献标志码:
A
摘要:
目的　探讨酪氨酸蛋白激酶CD117在非M3型急性髓系白血病(AML)患者的表达及其与AML患者疗效和预后的关系。
方法　选择2013年1月至2018年6月淮安市第一人民医院收治的83例初诊为非M3型AML患者为研究对象，根据骨髓原始细胞免疫表型流式细胞术检测结果将患者分为CD117抗原阴性组（CD117-组,n=40）和CD117抗原阳性组（CD117+组，n=43）,采用R显带技术分析AML患者的染色体核型，多重反转录聚合酶链式反应法检测AML患者的基因突变情况，结合患者染色体及基因突变结果，将所有患者预后分层为预后良好、预后中等、预后不良。所有患者根据病情选择以下诱导方案中的1种进行化学治疗：（1）IA方案［去甲氧柔红霉素10~12 mg·m-2(第1~3天) +阿糖胞苷100 mg·m-2(第1~7天)］；（2）DA方案［柔红霉素60~90 mg·m-2(第1~3天) +阿糖胞苷100 mg·m-2(第1~7天)］；（3）HA方案［高三尖杉酯碱2.5 mg·m-2(第1~7天) +阿糖胞苷100 mg·m-2(第1~7天)］。1个疗程后未达完全缓解（CR）的患者可选择原方案或更改诱导方案；达CR的患者选择中大剂量阿糖胞苷(1～2 g·m-2 ，12 h 1次，第1~4天)方案进行巩固化学治疗。患者均完成1个疗程及以上标准诱导化学治疗方案。观察所有患者的CR率、微小残留病（MRD）阴性率及总生存期（OS）。
结果　2组患者的染色体核型及FLT3、CEBPA、NPM1、C-kit等基因突变状态、预后分层比较差异无统计学意义（P>0.05）。CD117-组1个疗程后CR率为77.50％（31/40），CD117+组1个疗程后CR率为76.74％（33/43）；2组患者1个疗程后CR率比较差异无统计学意义（χ2=0.007，P>0.05）。CD117-组达CR患者的MRD阴性率为90.30％（28/31），CD117+组达CR患者的MRD阴性率为57.60％（19/33）；CD117-组达CR患者的MRD阴性率显著高于CD117+组（χ2=8.797，P<0.01）。CD117-组患者的中位OS为33.09［95％置信区间（CI）:28.22~37.97］个月，CD117+组患者的中位OS为20.61(95％CI:17.89~23.33)个月；CD117-组患者的中位OS显著长于CD117+组（P<0.01）。
结论　CD117与非M3型AML患者的MRD相关，是影响AML患者预后的因素，对指导AML患者的临床治疗具有重要意义。
Abstract:
Objective　To investigate the expression of tyrosine protein kinase CD117 in non-M3 acute myeloid leukemia (AML) patients and its relationship with the outcome and prognosis of AML patients.
Methods　A total of 83 newly diagnosed non-M3 AML patients admitted to the Huai′an First People′s Hospital from January 2013 to June 2018 were selected as the research subjects,and they were divided into the CD117 antigenic negative group (CD117- group,n=40) and CD117 antigenic positive group (CD117+ group,n=43) according to the immunophenotype flow cytometry detection of bone marrow original cells.The chromosome karyotype of AML patients was analyzed using the R-banding technique,and the gene mutation of AML patients was detected by multiplex reverse transcriptase polymerase chain reaction.Based on the results of chromosome karyotype and gene mutation,the prognosis of all patients was stratified into the good prognosis,the medium prognosis,and the poor prognosis.All patients were treated with one of the following induction regimens according to their condition:(1) IA regimen ［idarubicin 10-12 mg·m-2 (day 1-3) + cytarabine 100 mg·m-2 (day 1-7)］;(2) DA regimen ［daunorubicin 60-90 mg·m-2 (day 1-3) + cytarabine 100 mg·m-2 (day 1-7)］;(3) HA regimen ［homoharringtonine 2.5 mg·m-2 (day 1-7) + cytarabine 100 mg·m-2 (day 1-7)］.Patients who did not reach complete remission (CR) after the first course of induction could choose the original regimen or a new regimen.All patients with CR were treated with high-dose cytarabine (1-2 g·m-2,once in 12 hours,day 1-4) for consolidation chemotherapy.All patients completed one course or more of standard induction chemotherapy.The CR rate,minimal residual disease (MRD) negative rate and the overall survival (OS) of all patients were observed.
Results　There was no significant difference in chromosome karyotype,FMS-like tyrosine kinase 3 (FLT3),CCAAT/enhancer binding protein α (CEBPA),nucleophosmin 1 (NPM1) and C-kit gene mutations,and stratified prognosis between the two groups (P>0.05).The CR rates after the first treatment course in the CD117- and CD117+ groups were 77.50% (31/40) and 76.74% (33/43),respectively,showing no statistically significant difference between the two groups (χ2=0.007,P>0.05).The MRD negative rate of CR patients in the CD117- group was 90.30% (28/31),and the MRD negative rate in the CD117+ group was 57.60% (19/33).The MRD negative rate of CR patients in the CD117- group was significantly higher than that in the CD117+ group (χ2=8.797,P<0.01).The median OS was 33.09 ［95% confidence interval (CI):28.22-37.97］ months in the CD117- group and 20.61 (95%CI:17.89-23.33) months in the CD117+ group.The median OS in the CD117- group was significantly longer than that in the CD117+ group (P<0.01).
Conclusion　CD117 is associated with the MRD in non-M3 AML patients and affects the prognosis of AML patients.It is of great significance to guide the clinical treatment of AML patients.

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更新日期/Last Update: 2024-04-05