Laboratory diagnosis and prognostic factor analysis of core binding factor-related acute myeloid leukemia

doi:10.3969/j.issn.1673-8640.2024.07.010

Abstract

Abstract:

Objective To analyze the correlation of general clinical characteristics （age and gender），laboratory determination results with prognosis（efficacy，recurrence and survival time） in patients with core binding factor（CBF）-related acute myeloid leukemia （AML），and to provide a reference for optimizing clinical treatment plans. Methods A total of 116 CBF-AML patients who received standard induction and consolidation chemotherapy at Shanghai General Hospital from January 2014 to December 2021 were enrolled，including 77 cases who received allogeneic hematopoietic stem cell transplantation （allo-HSCT）. According to fusion genes，the subjects were classified into AML RUNX1::RUNX1T1 （Group 1） and AML CBFB::MYH11 （Group 2）. Kaplan-Meier survival analysis and Cox regression analysis were used to evaluate the prognostic factors. Results There was statistical significance in baseline characteristics between Group 1 and Group 2，including age at onset，peripheral blood white blood cell count，hemoglobin level，bone marrow blast percentage，incidence of additional chromosomal abnormalities，sex chromosome deletion，KRAS mutation and NRAS mutation（P<0.05）. The overall survival （OS） of patients with recurrence was lower than that of those without recurrence（P=0.008）. Male，recurrence，TET2 mutation and del（9q） were related with poor OS（P<0.05）. Patients with platelet count <20×10⁹·L^-1 had poor OS and relapse-free survival（RFS）（P<0.05）. The OS of patients who recurred after transplantation was worse than that of patients who did not recurr after transplantation（P=0.001）. Cox regression analysis showed that recurrence，TET2 mutation and chromosome del（9q） were risk factors for OS，and time to remission （days） was an independent influencing factor for OS in AML patients with RUNX1::RUNX1T1 （P=0.038）. The proportion of bone marrow blast percentage was an independent influencing factor for OS in AML patients with CBFB::MYH11（P=0.044）. Conclusions There is heterogeneity in baseline characteristics between the 2 fusion genes of CBF-AML patients. TET2 mutation and del（9q）significantly affect survival time. AML patients with RUNX1::RUNX1T1 should pay attention to the time to remission（days），recurred patients are recommended to undergo salvage transplantation in time，and CBFB::MYH11 patients should pay attention to the bone marrow blast percentage.

Key words: Acute myeloid leukemia, Core binding factor, Mutation, Recurrence, Laboratory diagnosis, Prognosis

CLC Number:

R733.71

DING Jing, ZHANG Chunling, WANG Xiaorui, LI Huidan, WANG Hongling, LIU Weiling, LIN Lihui, LI Li. Laboratory diagnosis and prognostic factor analysis of core binding factor-related acute myeloid leukemia[J]. Laboratory Medicine, 2024, 39(7): 673-681.

Figures/Tables 7

References 16

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组别	例数	外周血白细胞计数/（×10⁹·L^-1）	外周血血红蛋白/ （g·L^-1）	外周血血小板计数/（×10⁹·L^-1）	骨髓原始细胞百分比/%
第1组	71	11.50（1.12~272.20）	76.5（24.0~145.0）	30（4~623）	46.3（7.5~89.0）
第2组	45	34.79（0.43~379.82）	96.0（39.0~139.0）	36（7~185）	64.8（20.5~85.0）
统计值		-3.496	-2.791	-1.567	-3.263
P值		<0.001	0.005	0.117	0.001

组别	例数	外周血白细胞计数/（×10⁹·L^-1）	外周血血红蛋白/ （g·L^-1）	外周血血小板计数/（×10⁹·L^-1）	骨髓原始细胞百分比/%
第1组	71	11.50（1.12~272.20）	76.5（24.0~145.0）	30（4~623）	46.3（7.5~89.0）
第2组	45	34.79（0.43~379.82）	96.0（39.0~139.0）	36（7~185）	64.8（20.5~85.0）
统计值		-3.496	-2.791	-1.567	-3.263
P值		<0.001	0.005	0.117	0.001

组别	例数	CD34（APC）/[例（% ）]	CD117（A750）/[例（% ）]	CD13（PC5.5）/[例（% ）]	CD33（PC7）/ [例（% ）]	CD56（PE）/ [例（% ）]	CD19（PC7）/[例（% ）]	CD7（APC）/[例（% ）]	CD10（PE）/ [例（% ）]	HLA-DR（PB）/ [例（% ）]
第1组	33	32（97.0）	33（100.0）	26（78.8）	32（97.0）	25（75.8）	26（83.9）	5（16.7）	0（0）	32（97.0）
第2组	22	22（100.0）	22（100.0）	22（100.0）	22（100.0）	4（18.2）	2（9.1）	2（9.1）	0（0）	20（90.9）
χ²值		0.679	—	5.347	0.679	17.555	28.876	0.625	—	0.940
P值		1.000	1.000	0.034	1.000	<0.001	<0.001	0.685	1.000	0.557

组别	例数	CD34（APC）/[例（% ）]	CD117（A750）/[例（% ）]	CD13（PC5.5）/[例（% ）]	CD33（PC7）/ [例（% ）]	CD56（PE）/ [例（% ）]	CD19（PC7）/[例（% ）]	CD7（APC）/[例（% ）]	CD10（PE）/ [例（% ）]	HLA-DR（PB）/ [例（% ）]
第1组	33	32（97.0）	33（100.0）	26（78.8）	32（97.0）	25（75.8）	26（83.9）	5（16.7）	0（0）	32（97.0）
第2组	22	22（100.0）	22（100.0）	22（100.0）	22（100.0）	4（18.2）	2（9.1）	2（9.1）	0（0）	20（90.9）
χ²值		0.679	—	5.347	0.679	17.555	28.876	0.625	—	0.940
P值		1.000	1.000	0.034	1.000	<0.001	<0.001	0.685	1.000	0.557

组别	例数	额外染色体异常/[例（% ）]	复杂核型/ [例（% ）]	性染色体丢失/[例（% ）]	+8/ [例（% ）]	+22/ [例（% ）]	del（9q） / [例（% ）]
第1组	65	30（46.2）	3（4.6）	26（40.0）	2（3.1）	1（1.5）	3（4.6）
第2组	39	7（17.9）	2（5.1）	1（2.6）	1（2.6）	3（7.7）	0（0）
χ²值		8.460	0.014	17.772	0.023	2.496	1.853
P值		0.006	1.000	<0.001	1.000	0.147	0.290