摘要
目的:探讨基于形态学定义的急性髓系白血病伴骨髓增生异常相关改变(AML-MRC)的临床和遗传学特征。方法:收集并回顾性分析180例新发AML患者的临床资料,并对纳入研究的126例新发AML患者骨髓涂片重新评估,研究仅形态学多系发育异常(MLD)定义的AML-MRC-1组、基于骨髓增生异常综合征(MDS)、MDS/骨髓增殖性肿瘤(MPN)病史或无MLD但存在MDS相关遗传学异常定义的AML-MRC-2组和AML非特指型(AML-NOS)组患者的年龄和性别分布、WBC数、HGB水平、PLT数、原始细胞百分比、异常核型检出率等临床和遗传学特征。结果:AML-MRC-1、AML-MRC-2和AML-NOS这3组在性别和年龄分布及PLT数上差异无统计学意义(P=0.898,P=0.365, P=0.853),但60岁以上患者占比AML-MRC-2组(73.2%)高于AML-MRC-1组(60.0%)和AML-NOS组(56.4%)(P=0.228);3组的WBC数、HGB水平和原始细胞百分比都具有统计学差异(P=0.000, P=0.022, P=0.000),且AMLMRC-2组AML-MRC-1组(40.0%)>AML-NOS组(25.4%),差异有统计学意义(P=0.000)。AML-MRC-2组和AML-MRC-1组都以复杂核型和MDS相关异常为主,两组中复杂核型占比差异有统计学意义(41.5%vs 16.7%,P=0.026),其他MDS相关遗传学异常占比差异无统计学意义(17.1%vs20.0%,P=0.753)。结论:形态学评估新发AML患者细胞发育异常是仅形态学MLD定义的AML-MRC与AML-NOS鉴别诊断的重要依据,前者遗传学异常检出率更高,且以遗传学预后高危的复杂核型和MDS相关遗传学异常为主。
Objective: To explore the clinical and cytogenetic characteristics of acute myeloid leukemia with myelodysplasia-related changes(AML-MRC) based on morphology define. Methods: A total of 180 newly diagnosed acute myeloid leukemia(AML) patients were enrolled and retrospectively analyzed, and marrow cell morphology of 126 patients were re-evaluated. The clinical and cytogenetic characteristics, including ages, sex, WBC count, HGB level, PLT count, blasts percentage, abnormal karyotype detection rate of the patients in AML with multilineage dysplasia(AMLMRC-1), secondary AML from myelodysplastic/myeloproliferative neoplasms(MDS/MPN)(AML-MRC-2), and AML not otherwise specified(AML-NOS) groups were investigated. Results: There was no significant differences between the patients in three groups in terms of sex, age and platelet count(P=0.898, P=0.365, P=0.853), but AML-MRC-2 group(73.2%) was higher than AML-MRC-1(60.0%) and AML-NOS(56.4%) in the percentages of patients over 60 years old(P=0.228);there were statistically significant differences on WBC count, HGB level, and blasts percentage(P=0.000, P=0.022, P=0.000, AML-MRC-2<AML-MRC-1<AML-NOS). Abnormal karyotypes rate were 59.2% in AMLMRC patients, among which complex karyotypes and myelodysplasia-related cytogenetic abnormalities accounted for49.3%, and 5 q-was the most common(28.2%), followed by 7 q-/-7(19.1%), 17 p-/-17(14.1%), +8(14.1%), and 20 q-(12.7%). Cytogenetic abnormalities rate were compared between the patients in the three groups, the result showed that AML-MRC-2 group(73.2%) was higher than AML-MRC-1 group(40.0%) and AML-NOS group(25.4%)(P=0.000).Complex karyotypes and myelodysplasia-related abnormalities were the main abnormalities in AML-MRC-2 and AMLMRC-1 group, the percentages of complex karyotypes of the patients in the two groups showed statistically significant(41.5% vs 16.7%, P=0.026), while the percentages of other myelodysplasia-related abnormalities showed no statistically significant(17.1% vs 20.0%, P=0.753). Conclusion: Morphological reasse
作者
马金龙
周安琪
顾思雨
陈宝安
葛峥
MA Jin-Long;ZHOU An-Qi;GU Si-Yu;CHEN Bao-An;GE Zheng(Department of Hematology ofZhongda Hospital,Medical School of Southeast University,Institute of Hematology Southeast University,Nanjing 210009,Jiangsu Province,China)
出处
《中国实验血液学杂志》
CAS
CSCD
北大核心
2021年第6期1757-1762,共6页
Journal of Experimental Hematology
基金
国家自然基金面上项目(81770172)
江苏省重点研发项目(BE2017747)
江苏省“333人才工程”项目(BRA2019103)
南京市卫生科技发展专项资金项目计划(YKK18262)
江苏省医学重点学科项目(ZDXKB2016020)。
