正常染色体核型的急性髓细胞白血病中相关基因突变的临床研究
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国家自然科学基金(81200362,81070456, 81270652);江苏高校优势学科建设工程资助项目


Associated gene mutations in patients with cytogenetically normal acute myeloid leukemia
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    摘要:

    目的:研究NPM1-CEBPA-FLT3-ITD及c-kit基因突变在正常染色体核型的急性髓细胞白血病(CN-AML)患者中的临床意义。方法:收集112例初诊AML患者骨髓标本,分离单个核细胞(MNCs),提取DNA。采用改良的热处理姬姆萨R显带技术分析染色体核型。运用基因组PCR及测序进行NPM1-CEBPA-FLT3-ITD及c-kit基因突变检测。分析4种突变在CN-AML中的发生率,比较突变型与野生型患者临床特征-生存期及累积复发率的差异。Cox回归分析研究CN-AML患者各项临床特征及突变状态等因素在总生存期(OS)中的预后意义。结果:112例CN-AML患者中NPM1-CEBPA-FLT3-ITD及c-kit的突变率分别为21.4%-21.4%-13.4%和5.4%。NPM1突变型患者的白细胞(WBC)显著高于野生型患者;FLT3-ITD及c-kit突变型患者的血小板(PLT)明显低于野生型患者,而外周血(PB)及骨髓(BM)的原始细胞比例明显高于野生型患者。排除放弃治疗及异基因造血干细胞移植的患者后,孤立的NPM1突变患者的OS较野生型患者明显延长;孤立的CEBPA突变型患者的OS及无病生存期(DFS)均较野生型患者明显延长;孤立的CEBPA突变患者的累积复发率明显低于野生型患者。Cox回归分析结果显示年龄与BM原始细胞比例高是OS独立的预后指标,CEBPA突变状态与OS相关。结论:在CN-AML中存在一定比例的NPM1-CEBPA-FLT3-ITD及c-kit突变,其中NPM1与CEBPA突变率较高。FLT3-ITD及c-kit突变患者具有较低的PLT及较高的原始细胞比例。孤立的NPM1与CEBPA突变与良好预后相关。

    Abstract:

    Objective:To explore the prognostic significance of NPM1,CEBPA,FLT3-ITD and c-kit gene mutations in cytogenetically normal acute myeloid leukemia (CN-AML). Methods:Bone marrow (BM) samples of 112 patients with CN-AML were collected. Mononuclear cells (MNCs) were extracted and genomic DNA was isolated from BM specimens. Chromosome specimens were prepared using the direct method and short-term culture without phytohemagglutinin and the metaphase chromosomes were banded via improved heat treatment Giemsa R-banding method. Incidence of NPM1,CEBPA,FLT3-ITD and c-kit gene mutations was analyzed using genomic PCR and sequencing. Clinical characteristic,overall survival (OS),disease-free survival (DFS) and cumulative incidence of relapse rate were compared between gene mutant and wild-type patients. Cox regression analysis was performed to estimate the significantly prognostic factors for OS. Results:Incidence of NPM1,CEBPA,FLT3-ITD and c-kit mutation was 21.4%,21.4%,13.4% and 5.4%,respectively. WBC count of the patients with mutational NPM1 was significantly higher than that with wild-type NPM1. Patients with mutant FLT3-ITD or c-kit had significantly lower PLT,higher PB and BM blast proportion than those with wild-type genes. After excluding the patients giving up treatment and undergoing allo-SCT,patients with isolated NPM1 mutations had significantly better OS compared to wild-type patients. Patients with isolated mutated CEBPA had significantly better OS and DFS compared with the wild-type patients. Patients with CEBPA mutation had a significantly lower cumulative relapse rate than the wild-type patients. Cox regression analysis showed that age and BM blast proportion were independent prognostic factors for OS,and CEBPA mutations were associated with OS. Conclusion:FLT3-ITD and c-kit mutations were associated with lower PLT count and higher blast proportion in PB and BM. Isolated NPM1 and CEBPA mutations were associated with better prognosis in CN-AML.

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景传红,乔 纯,郭 睿,张 弛,张苏江,钱思轩,李建勇,洪 鸣.正常染色体核型的急性髓细胞白血病中相关基因突变的临床研究[J].南京医科大学学报(自然科学版),2013,(12):1687-1692

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  • 收稿日期:2013-05-23
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  • 在线发布日期: 2013-12-26
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