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目的研究多因素对AML-M2型患者疗效及预后的影响。方法用逆转录聚合酶链反应(reverse transcription polymerase chain reaction,RT-PCR)技术检测47例初诊M2型患者AML1／ETO融合基因的表达、R带法染色体核型分析、免疫分型检测,同时结合临床资料分析其预后影响因素。结果 1)47例初诊患者中具有t(8;21)伴其他各种复杂染色体异常26 例,正常核型12例及其他复杂染色体异常9例。具有单纯t(8;21)者预后较佳,完全缓解(CR)率高;伴有附加复杂异常预后相对较差,尤其-Y和9q-的t(8;21)者CR率低。2)47例AML-M2中具有AML1/ETO融合基因组占51．1％(24／47),无AML1/ ETO融合基因占48．9％(23／47)。两组诱导达缓解率无明显差别。3)2例高龄及10例高白细胞数常规化疗难达缓解,诱达缓解后短期内(6-10月)又复发。结论伴有附加复杂异常的t(8;21)染色体对预后有不良影响;AML1／ETO融合基因对判断预后、微小残留病及复发有特殊意义;高白细胞及高龄均为预后不良指标。
Objective To investigate the effect of multiple factors on the efficacy and prognosis of AML-M2 patients. Methods The expression of AML1 / ETO fusion gene was detected by reverse transcription polymerase chain reaction (RT-PCR) in 47 patients with newly diagnosed M2 type. R-band karyotype analysis, immunophenotyping and simultaneous Clinical data analysis of its prognostic factors. Results 1) Among the 47 newly diagnosed patients, t (8; 21) had other complex chromosomal abnormalities in 26 cases, normal karyotype in 12 cases and other complex chromosomal abnormalities in 9 cases. Patients with simple t (8; 21) had a better prognosis and a higher complete remission (CR) rate. Patients with associated complex abnormalities had a poorer prognosis, especially those with t (8; 21) at -Y and 9q-. 2) The AML1 / ETO fusion genome of 51 AML-M2 patients accounted for 51.1% (24/47), while the AML1 / ETO fusion gene-free genes accounted for 48.9% (23/47). There was no significant difference between two groups in inducing remission rate. 3) 2 cases of elderly and 10 cases of high white blood cells in conventional chemotherapy refractory remission, short-term after induction of remission (6-10 months) recurrence. Conclusions The t (8; 21) chromosome with additional complex abnormalities has an adverse effect on prognosis. The AML1 / ETO fusion gene has special significance in judging prognosis, minimal residual disease and recurrence. Both high white blood cells and advanced age are poor prognostic indicators.