FLT3-ITD阳性急性髓系白血病免疫表型及临床特征研究

冯会欣; 杨艳丽; 耿英华

doi:10.16766/j.cnki.issn.1674-4152.001864

FLT3-ITD阳性急性髓系白血病免疫表型及临床特征研究

doi: 10.16766/j.cnki.issn.1674-4152.001864

蚌埠医学院第一附属医院血液科，安徽蚌埠 233004

基金项目:

安徽省高校自然科学研究重点项目 KJ2019A0375

安徽省科技发展基金项目 BYKF1885

蚌埠医学院2019年研究生科研创新计划项目 Byycxz1919

详细信息

通讯作者:
杨艳丽, E-mail: yangyanli0702@126.com

中图分类号: R733.71 R446
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- 被引次数: 0
出版历程
- 收稿日期: 2020-05-29
- 网络出版日期: 2022-02-16

Immunophenotype and clinical characteristics of acute myeloid leukaemia with positive FLT3-ITD

Department of Haematology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探索伴有FMS样酪氨酸激酶3-内部串联重复(fms-like tyrosine kinase 3, FLT3-ITD)突变的急性髓系白血病(AML)患者的免疫表型及临床特征。方法收集2016年12月—2018年12月蚌埠医学院第一附属医院103例初诊AML患者(除外M3型)，其中FLT3-ITD⁺患者24例(阳性组)，FLT3-ITD^-患者79例(阴性组)。对2组患者的临床特征和免疫表型进行回顾性研究，统计2组患者治疗总反应率(overall reaction，OR)、无进展生存时间(progression free survival，PFS)与总生存时间(overall survival, OS)。结果阳性组患者CD33、CD7、CD56及CD38抗原表达率较阴性组明显升高(均P < 0.05)，而CD13、CD34表达率则显著降低(均P < 0.05)；阳性组患者外周血白细胞计数、血红蛋白计数、骨髓原始细胞比例、合并NPM1(Nucleophosmin)突变率明显高于阴性组(均P < 0.05)；阴性组患者治疗总反应率为78.48%，明显优于阳性组的33.33%，差异有统计学意义(P < 0.001)。阳性组患者中位OS为9.5个月，中位PFS为9个月；阴性组患者中位OS为17个月，中位PFS为16个月，阴性组较阳性组明显延长(P < 0.05)。结论 FLT3-ITD阳性AML患者白血病细胞抗原表达紊乱，外周血白细胞、血红蛋白、骨髓原始细胞高，易合并NPM1突变且治疗总反应率低，PFS和OS明显缩短，治疗效果差，预后不良。
- 急性髓系白血病 /
- FLT3-ITD突变 /
- 免疫表型 /
- 临床特征
Abstract: Objective To explore the immunophenotype and clinical characteristics of patients with acute myeloid leukaemia (AML) with fms-like tyrosine kinase 3-internal tandem replication (FLT3-ITD) mutation. Methods A total of 103 patients with AML (excluding the M3 type), including 24 patients with FLT3-ITD⁺ (positive group) and 79 patients with FLT3-ITD^- (negative group), who were initially diagnosed in the haematology department of the First Affiliated Hospital of Bengbu Medical College from December 2016 to December 2018 were enrolled in this study. The clinical haematological characteristics and immunophenotypes of the two groups were retrospectively studied. The patients in both groups were followed up, and the overall reaction rate (OR), progress-free survival (PFS) and overall survival (OS) were calculated. Results The expression rates of CD33, CD7, CD56 and CD38 in the FLT3-ITD⁺group were significantly higher than those in the FLT3-ITD^- group (all P < 0.05). By contrast, the expression rates of CD13 and CD34 were low (all P < 0.05). White blood cell count, haemoglobin count, bone marrow leukaemia cells and mutation rate of combined NPM1 in the FLT3-ITD⁺ group were higher than those in the FLT3-ITD^- group (all P < 0.05). after the treatment the Objective response rate in the FLT3-ITD^- group (78.5%) was significantly higher than that in the FLT3-ITD⁺ group (33.3%), and the difference was statistically significant (P < 0.001). The median OS and PFS in the FLT3-ITD⁺ group were 9.5 and 9 months, respectively, and those in the FLT3-ITD^- group were 17 and 16 months, respectively. The OS and PFS of the FLT3-ITD^- group were longer than those of the FLT3-ITD⁺ group (P < 0.05). Conclusion Patients with AML with FLT3-ITD⁺ have abnormal expression of leukaemia cell antigen, high peripheral blood leukocytes, abundant haemoglobin and bone marrow primordial cells, are prone to NPM1 mutation, have shortened PFS, OS and reduced the response rate. Hence, the treatment effect and prognosis of these patients are poor.
- Acute myeloid leukaemia /
- FLT3-ITD mutation /
- Immunophenotype /
- Clinical characteristics

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图 1 2组AML患者的总生存曲线比较

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图 2 2组AML患者的无病生存曲线比较

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表 1 2组初诊AML患者临床资料对比(x ±s)

组别	例数	年龄(岁)	性别(女/男，例)	白细胞计数(×10⁹个/L)	血小板计数(×10⁹个/L)	血红蛋白(×10⁹个/L)	骨髓原始细胞比例/(%)	分型[例(%)]							合并NPM1突变率[例(%)]
组别	例数	年龄(岁)	性别(女/男，例)	白细胞计数(×10⁹个/L)	血小板计数(×10⁹个/L)	血红蛋白(×10⁹个/L)	骨髓原始细胞比例/(%)	M0	M1	M2	M4	M5	M6	M7	合并NPM1突变率[例(%)]
FLT3-ITD阳性组	24	52.58±18.63	8/16	73.78±68.54	52.67±42.26	88.50±23.10	75.57±19.72	0(0.0)	4(16.7)	10(41.7)	3(12.5)	6(25.0)	1(4.2)	0(0.0)	15(62.50)
FLT3-ITD阴性组	79	52.39±17.58	34/45	30.31±83.89	48.00±48.73	77.59±23.37	63.02±26.37	1(1.3)	7(8.7)	38(48.1)	21(26.6)	10(12.7)	1(1.3)	1(1.3)	16(20.25)
统计量		0.046^a	0.797^b	2.310^a	0.423^a	2.008^a	2.709^a	5.991^b							15.294^b
P值		0.963	0.372	0.023	0.673	0.047	0.009	0.424							< 0.001
注：^a为t值，^b为χ²值。

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表 2 2组AML患者LC抗原表达率比较[例(%)]

组别	例数	CD56	CD13	CD34	CD38	CD7	CD33
FLT3-ITD⁺组	24	8(33.33)	14(58.33)	12(50.00)	21(87.50)	8(33.33)	22(91.67)
FLT3-ITD^-组	79	10(12.66)	63(79.75)	60(75.95)	51(64.56)	11(13.92)	57(72.15)
χ²值		5.456	4.473	5.892	4.606	4.606	3.923
P值		0.020	0.034	0.015	0.032	0.032	0.048

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表 3 2组AML患者首次诱导化疗反应[例(%)]

组别	例数	CR	PR	NR
阳性组	24	5(20.83)	3(12.50)	16(66.67)
阴性组	79	35(44.30)	27(34.18)	17(21.52)
Z值		-3.427
P值		0.001

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