摘要
目的探讨WT1基因水平监测对造血干细胞移植(HSCT)后正常核型急性髓系白血病(AML)患者预后的意义。方法回顾性分析2009年7月至2017年3月于苏州大学附属第一医院接受HSCT的115例正常核型AML患者临床资料,采用实时荧光定量聚合酶链反应(RT-PCR)动态检测骨髓WT1基因表达水平。根据患者移植前WT1基因相对表达水平中位数,将115例患者分为两组(<中位数组和≥中位数组)进行生存分析。结果115例患者男性52例,女性63例,年龄(39±10)岁。初诊时中位白细胞计数20.45×10^9/L[(0.5~355.9)×10^9/L],骨髓中原幼细胞比例为0.60±0.28,WT1基因中位相对表达水平为87×10^4。中位随访时间24个月(3~79个月)。115例患者中19例患者复发,对缓解组(96例)及复发组分别进行随访,在移植后1、3、6、12个月进行骨髓穿刺监测WT1基因水平,发现复发组的WT1基因相对表达水平高于缓解组,其中移植后6个月[缓解组(187±50)×10^4,复发组(871±211)×10^4,t=2.519,P=0.014]、12个月[缓解组(51±9)×10^4,复发组(1 797±312)×10^4,t=4.000,P<0.05]的WT1基因相对表达水平差异有统计学意义。WT1基因相对表达水平<87×10^4组2年总生存(OS)率、无进展生存(PFS)率均高于WT1相对表达水平≥87×10^4组,复发率低于WT1相对表达水平≥87×10^4组,两组间比较差异均有统计学意义(均P<0.05)。多因素分析显示,患者移植后12个月的WT1基因水平是影响OS(HR=4.12,P=0.046)及PFS(HR=5.95,P=0.001)的独立因素。19例复发患者中位复发时间11个月(1~60个月)。复发患者在WT1基因相对表达水平明显增高时均首先减停免疫抑制剂,其中6例患者对干预无效,余13例患者中仅5例对干预有效。结论正常核型AML患者移植前的WT1基因表达水平与预后呈负相关。移植后12个月的WT1基因表达水平是影响患者生存的独立因素。复发患者的WT1基因表达水平较高,可对复发患者进行临床干预,较为有效。
Objective To investigate the monitoring significance of WT1 gene level in the prognosis of acute myeloid leukemia (AML) patients with normal karyotype after hematopoietic stem cell transplantation (HSCT).Methods The clinical data of 115 AML patients with normal karyotype who were treated with HSCT from July 2009 to March 2017 in the First Affiliated Hospital of Soochow University were retrospectively analyzed.The dynamic detection of bone marrow WT1 gene was carried out by using reverse transcription- polymerase chain reaction (RT-PCR).According to the relative expression level median of WT1 gene before transplantation,the whole patients were divided into the two groups (< median group and ≥ median group) for survival analysis.Results There were 52 males and 63 females in 115 patients.The average age was (39±10) years old.The median white blood cell count at initial diagnosis was 20.45×10^9/L [(0.5-355.9)×10^9/L],the ratio of blast cells in the bone marrow was 0.60±0.28,and the relative expression level median of WT1 gene was 87×10^4,while the median time of the follow-up was 24 (3-79) months.Among 115 patients,19 cases relapsed.Remission group (96 cases) and relapse group (19 cases) were followed up.The WT1 gene level was monitored by using bone marrow puncture in 1 month,3 months,6 months,12 months after transplantation.It was found that the WT1 gene relative expression level of relapse group was higher than that of remission group,and the differences between the two groups at 6 month-point [remission group (187±50)×10^4,relapse group (871±211)×10^4,t=2.519,P=0.014] and 12 month-point [remission group (51±9)×10^4,relapse group (1 797±312)×10^4,t=4.000,P < 0.05] were statistically different.The overall survival (OS) rate of 2-year,progression-free survival rate in WT1 gene relative expression level < 87×10^4 group were higher than those in WT1 gene relative expression level ≥ 87×10^4 group,the relapse rate in WT1 gene relative expression level < 87×10^4 group was lower than that in WT1 gene r
作者
孙妍珺
徐杨
岑建农
仇惠英
陈苏宁
孙爱宁
吴德沛
Sun Yanjun;Xu Yang;Cen Jiannong;Qiu Huiying;Chen Suning;Sun Aining;Wu Depei(Clinical Medicine College,Suzhou Vocational Health College,Suzhou 215006,China;Department of Hematology,the First Affiliated Hospital of Soochow University,Jiangsu Institute of Hematology,Suzhou 215006,China)
出处
《白血病．淋巴瘤》
CAS
2019年第4期198-204,共7页
Journal of Leukemia & Lymphoma
基金
国家自然科学基金面上项目(81270617、81470346)
江苏省科教兴卫工程-临床医学中心项目(ZX201102)
江苏省血液病临床医学研究中心项目(江苏省科技厅生命健康专项)(BL2012005).
关键词
基因
WT1
造血干细胞移植
白血病
髓样
急性
预后
Gene, WT1
Hematopoietic stem cell transplantation
Leukemia, myeloid, acute
Prognosis
