FLT3-ITD及CEBPA基因共突变成人急性髓系白血病患者的临床特征及预后分析

OBJECTIVE: To investigate the clinical characteristics and prognosis in adult acute myeloid leukemia (AML) patients with FLT3-ITD and CEBPA double-mutated (CEBPAdm) co-mutation. METHODS: Clinical data and prognostic factors were retrospectively analyzed in adult AML patients with FLT3-ITD and CEBPAdm co-mutation at The First Affiliated Hospital of Zhengzhou University from January 2016 to September 2018. RESULTS: Among 599 non-acute promyelocytic leukemia (APL) patients, 268 received gene mutation detection, who were divided into 4 groups including 19 FLT3-ITD positive (FLT3-ITD(+)) and CEBPAdm positive (CEBPAdm(+)) cases (group A), 84 FLT3-ITD(+) and CEBPAdm(−) cases (group B), 95 FLT3-ITD(−) and CEBPAdm(+) cases (group C), 70 double negative mutation cases (group D). Gender, platelet count, FAB classification, induction treatment regimen and fusion gene mutation were comparable among four groups (P>0.05), while age onset, peripheral white blood cell (WBC) count, hemoglobin, percentage of blasts in peripheral blood, percentage of blasts in bone marrow, complete remission rate (CR(1) rate) after the first induction chemotherapy, the relapse rate, the median progression-free survival (PFS) time, and median overall survival (OS) time were significantly different between groups (P<0.05). When compared in pairs, gender, age onset, hemoglobin, platelet count, FAB classification in group A were not statistically different compared to group B, C and D (P>0.05), while patients in group A had higher WBC count, blasts in peripheral blood, minimal residual disease (MRD) in bone marrow. The CR(1) rates of group A, B, C, and D were 50.0%、32.4%、59.8%、39.0% respectively (P=0.003), and the relapse rates were 55.6%, 50.0%, 21.1%, 40.0% (P<0.001). As to survival, the median OS in each group was 6.25, 3.0, 15.5, 10.5 months respectively (P<0.001), and the median PFS was 5.0, 4.0, 10.0, 6.7 months (P=0.032). CONCLUSION: Adult AML patients with FLT3-ITD and CEBPAdm co-mutation have a higher leukemia load and low CR(1) rate, which translates into poor prognosis with high relapse rate and short survival time.