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Background Acute myeloid leukemia (AML) is a set of biological characteristics of hematopoietic stem cells with a high degree of heterogeneity abnormal clonal disease. More complex factors affect AML prognosis, including cytogenetic onset immune phenotype and clinical characteristics. Currently, the age at diagnosis and cytogenetic be considered the most important factors that affect acute myeloid leukemia prognosis, but using conventional cytogenetic techniques (conventional cytogenetics) karyotype adult AML the exception detection rate of approximately 52% -78% , there are still about 45% of the AML showed a normal karyotype, while a small portion of patients with non-mitotic phase cytogenetic information can not be obtained, and AML stratification and increasing emphasis on molecular biology flag also because not all patients can be detected, and difficult to diagnose patients stratified. Therefore looking for other simple and universal application of prognostic factors for patients with significant prognostic stratification. Leukemia Immunophenotyping differentiation antigen expression angle to recognize leukemia cells cloned from hematopoietic cell clones in the evolutionary process, it is the use of monoclonal antibodies (monoclonal antibody, McAb) detection of leukemia cells in the cell membrane and cytoplasmic antigens, analyze the phenotype understand leukemia the cell belongs Series and their degree of differentiation. Immunophenotyping, not only for the diagnosis of AML patients is important judgment is also of great significance for the prognosis of patients with AML, but about the relationship between immune phenotype and prognosis of AML patients, there are more controversial, some scholars think that the immune phenotype The prognosis of AML patients no obvious correlation between immune phenotype and prognosis of AML patients most scholars that there is a correlation. Reported more prognostic antigen CD7, CD11b, CD13, CD14, CD34, CD56, CD117, HLA-DR, etc., has been reported to the antigen expression and prognosis negative correlation, also reported in the literature the above antigen expression in no prognostic significance in AML patients. Domestic immune phenotype and prognosis, sample more than 300 cases reported rarely, and therefore the need for further research and discussion. Objective 1 expression in AML patients to explore the relationship between immune phenotype and prognosis of AML patients; 2. Understand karyotype AML patients, analysis of the prognostic significance of karyotype AML patients. Understanding of immune markers in this group of patients; 3. analysis of the AML patient age, WBC, PLT, Hb and prognosis in newly diagnosed. Method 1, January 2000 to December 2009 were treated in our hospital 510 patients with newly diagnosed AML patients as the research object, MICM classification diagnosis all patients underwent a bone marrow cell morphology, immunophenotyping checks, 465 cases (91.2%) AML patients with chromosome karyotype analysis. Retrospective analysis of the clinical data of the selected cases, analysis of the contents, including the patient's age, FAB subtype, immunophenotype, karyotype at diagnosis the WBC, PLT, Hb and chemotherapy in patients with the situation, and analysis of these indicators and prognosis relationship. Prognosis evaluation: (1) clinical efficacy (2 cycles of chemotherapy after evaluation): complete remission rate (CR rate); (2) survival time of patients; (3) early death analysis. 4, statistical methods: application of statistical software SPSS13.0 statistics, clinical efficacy analysis: analysis compared by chi-square test (Pearson Chi-Square or Fisher's Exact Test), two significant factors (P lt; 0.05) classification of non-conditional logistic regression analysis. Survival time analysis: using the Kaplan-Meier method Log Rank test was used to compare the survival time difference, then meaningful factor in the Cox proportional hazards model analysis, P lt; 0.05 as there are significant differences in criteria. Results of a case characteristics and general data characteristics of 510 cases of de novo AML patients, male 295 cases (57.8%), 215 cases of women (42.2%), aged 12-83 years old, with a median age of 36 years, FAB typing: M126 , M2147 cases =, M378, M460, cases, M5 109 cases, M6 10 cases, M75 cases, AML-75 cases untyped. Karyotype (1) chromosome karyotype: 422 patients karyotype results, the abnormal karyotype detection rate was 68.2%, normal karyotypes 31.8%, complex abnormalities 14.0%, non-complex abnormalities 54.2%, which The most common abnormal karyotype t (15; 17), followed by the t (8; 21). Stratified according to WHO karyotype risk groups: low-risk group, 106 patients (25.1%), intermediate risk group in 214 cases (50.7%), the high-risk group of 102 cases (24.2%). (2) The relationship between age and karyotype: Age ≥ 50-year-old group of complex karyotype abnormality rate was 21.3%, higher than the age lt; 11.9% of the 50-year-old group, the difference between the two groups was significantly significance (X2 = 5.352, P = 0.021). 3 the immune phenotype situation AML patients with myeloid antigen expression: the expression rate the level of CD13 (86.3%), CD33 (79.4%), CD117 (55.4%), CD64 (45.8%), CD11b (23.4%) , CD 14 (8.4%); non-series-specific antigen expression: CD34 (58.9%), HLA-DR (66.9%); lymphoid antigen expression: this group 37.6% AML patients with lymphoid antigen expression mainly: CD7 (29.2%), CD56 (18.9%), CD10 (12.5%), CD2 (8.7%), CD 19 (8.5%). M3 patients lack of CD34 and HLA-DR expression lymphoid antigen expression in M3 was significantly lower than other subtypes. 4 early death and efficacy, prognostic analysis of 510 patients with previously untreated cases the M378 cases of early death in 5 cases. Prognostic analysis of 432 patients with non-M3 patients, early death in 27 cases (6.3%) of 432 patients with AML exclude M3 for various reasons did not receive chemotherapy or not, 41 cases (9.5%) patients completed both treatment and above chemotherapy, 364 cases (84.2%) AML patients completed the two treatments and more chemotherapy, the CR rate of 62.4% after 2 cycles of chemotherapy. The median follow-up time of 13 (0-129) months in 432 patients with non-M3 AML patients. 4.1 Early death analysis (1) FAB subtype M5, M4 and early mortality than other types of high; (2) Age is an important factor affecting early death, and ≥ 60 years of age AML patients have a higher early mortality; (3 WBC count) early death with newly diagnosed related to high early mortality of patients with high white blood cell; platelets less than 20G / L (4) onset AML patients early mortality rate is higher than the other groups; (5) complex complex karyotype AML patients with early mortality is higher than other groups, t (8; 21) in patients with abnormal low early mortality; (6) this group is not immune phenotype is directly related to the early death. (7) in this group, each induction chemotherapy the TA induction chemotherapy in higher early mortality. 4.2 Clinical efficacy and survival prognosis analysis (1) FAB subtypes and clinical efficacy: FAB subtype M1 patients after chemotherapy, the lowest CR rate, the highest rate of M2 patients with CR, CR rates between the various subtypes difference was statistically significant (X2 = 13.041, P = 0.023). (2) the relationship between age and prognosis, age ≥ 50 years group CR rate is below the age lt; 50-year-old group, the difference between the two groups was statistically significant (X2 = 4.125, P = 0.042); Age lt; 50-year-old group The median survival time compared head of ≥ 50 years of age (X2 = 4.142, P = 0.040). (3) when routine blood relationship with prognosis in newly diagnosed: 1) when newly diagnosed WBC ≥ 50G / L CR rate is lower than the WBC lt; 50G / L group, the differences between the two groups was statistically significant (X2 = 13.896, P lt; 0.001), newly diagnosed WBC ≥ 50G / L group bit shorter survival (X2 = 7.462, P = 0.006). 2) newly diagnosed when the CR rate lower than PLT ≥ 30G / L CR rate is lower than the PLT lt; 30G / L group, the difference between the two groups was statistically significant (X2 = 4.948, P = 0.026) between the two groups in the bit survival of the difference was not statistically significant (X2 = 0.582, P = 0.445) (4) cytogenetic prognosis) different karyotype and prognosis: with t (8; 21) abnormal karyotype group CR rate high, long median survival period, the prognosis is good, with the No. 5 or No. 7 chromosomal abnormalities and complex karyotype CR rate, median survival time is short, the prognosis is poor, normal karyotype group and associated with abnormal group prognosis medium CR rate and median survival time differences between the different karyotype groups were statistically significant (P = 0.001 and 0.000, respectively). 2) According to the WHO karyotype risk stratification standard: CR rate of the low-risk group, the median survival a long period, the prognosis is good, the CR rate of the high-risk group, the median survival time is short, the prognosis is poor, intermediate risk group prognosis referral among the three groups in between the two groups, the CR rate and median survival time were statistically significant (P = 0.000 and 0.002, respectively). (5) immune phenotype and prognosis) by naive cell surface antigen positive rate of 20%, positive standard grouping lower than CD10, CD10, CD11b-positive CR rate of CD11b-negative group, the difference was statistically significant between the two groups (P = 0.001 and 0.043), but the difference was not statistically significant (P = 0.129 and 0.325) between the two groups in median survival time. CR rate and median survival period was no significant difference between the rest of the antigen-positive and negative groups. Antigen co-expression with prognosis: CD13/CD34 co-expression of the group, the median survival compared to co-expression of the head of the difference between the two groups was statistically significant (X2 = 4.154, P = 0.042), the CR rate differences between the two groups no statistical significance (X2 = 2.176, P = 0.140). 2) naive cell surface antigen positive rate of 50% threshold to group, defined as ≥ 50% of the high-level expression results: CD13 expressed at high levels CR rate and median survival time were better than the high-level expression of group two differences between the groups were statistically significant (P = 0.024 and 0.038); of CD34 expressed at high levels CR rate and median survival time were better than the high-level expression group, there were significant differences between the two groups (P values ??of 0.020 and 0.047, respectively). (6) multi-factor analysis: two classification of non-conditional logistic regression analysis: CD10 positive expression of high levels of CD34 expression karyotype risk stratification in three factors with independent prognostic value. Cox proportional hazards model analysis: the first course of chemotherapy after remission risk karyotype AML patients with a median survival time stratified two factors have independent prognostic value. Conclusion AML patients age, cytogenetic factors and WBC count in the first visit to the most important factors affecting AML prognosis; Age, initial WBC, PLT, karyotype AML patients early death related; newly diagnosed the PLT and CR rate related. Immune phenotype in CD10, CD11b, CD13, CD34 expression is associated with clinical outcome, immune phenotype certain value in predicting prognosis and guide treatment of patients with AML prognosis of AML patients immunophenotype, cytogenetics and clinical features should be integrated data analysis, reasonable risk stratification diagnosis of AML patients, and give individualized treatment.
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