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目的:分析酪氨酸激酶受体基因FLT3突变在急性髓系白血病(AML)复发前后的变化及其对预后的影响。方法:22例在初诊及复发后均行FLT3-ITD/TKD检测的AML患者中,初诊时FLT3-ITD/TKD突变阳性者(FLT3+组)与阴性者(FLT3-组)各11例。分析2组患者临床基本特征、复发后FLT3突变转阳率、二次缓解率、无病生存(DFS)及总生存(OS)。结果:FLT3+组复发后,FLT3突变转阳率为90.9%(10/11),二次缓解率为9.1%(1/11);FLT3-组复发后,FLT3突变转阳率为27.3%(3/11),二次缓解率为27.3%(3/11)。2组间二次缓解率比较差异无统计学意义(P=0.586)。FLT3+组中位DFS为5(2~22)个月,FLT3-组中位DFS为5(3~19)个月,差异无统计学意义(P=0.531)。FLT3+组中位OS为12(7~33)个月,FLT3-组中位OS为15(6~40)个月,差异无统计学意义(P=0.208)。结论:AML伴有初诊FLT3+患者预后较差,该突变具有不稳定性,因而作为微小残留病的监测指标需慎重。
Objective: To analyze the change of FLT3 mutation of tyrosine kinase receptor gene before and after the relapse of acute myeloid leukemia (AML) and its effect on prognosis. Methods: Twenty-two patients with FLT3-ITD / TKD in the group of FLT3-ITD / TKD positive patients (FLT3 + group) and the negative group (FLT3- group) were newly diagnosed in each of the 11 patients with newly diagnosed and relapsed patients. The basic clinical features, FLT3 mutation positive rate, secondary remission rate, disease free survival (DFS) and overall survival (OS) were analyzed. Results: The recurrence rate of FLT3 mutation was 90.9% (10/11) and the second remission rate was 9.1% (1/11) in FLT3 + group. The FLT3 mutation rate was 27.3% (3) after FLT3- / 11), the second remission rate was 27.3% (3/11). There was no significant difference in the second remission rate between the two groups (P = 0.586). The median DFS was 5 (2-22) months in FLT3 + group and 5 (3- 19) months in FLT3- group, with no significant difference (P = 0.531). The median OS was 12 (7 ~ 33) months in FLT3 + group and 15 (6 ~ 40) months in FLT3 - group, with no significant difference (P = 0.208). Conclusion: The prognosis of AML with newly diagnosed FLT3 + patients is poor. The mutation is unstable and therefore should be carefully monitored as a marker for minimal residual disease.