ABSTRACT
Objective To investigate the frequency of NPM1 mutation and its clinical significance in patients with cytogenetically normal acute myeloid leukemia (CN-AML). Methods The data of 190 patients with CN-AML were collected from Department of Hematology, Tongji Hospital between January 2008 and June 2015, and the discrepancies in clinical features and efficacy between CN-AML patients with NPM1 mutation and those without NPM1 mutation were also analyzed. Results Among the 190 CN-AML patients, NPM1 mutation was found in 44 patients (23.16 %). The proportion of bone marrow blast cells and the count of peripheral white blood cells in patients with NPM1 mutation were higher than those in patients without NPM1 mutation (75.82 % vs. 63.87 % , P <0.05; 75.7 ×109/L vs. 60.0 ×109/L, P <0.05). The rate of response (complete remission + partial remission) in patients with NPM1 mutation was also higher than that in patients without NPM1 mutation [70.09 %(22/31) vs. 56.91 %(45/79), P<0.05) ]. Conclusion NPM1 mutation is associated with higher tumor burden and higher remission rate in CN-AML patients.
ABSTRACT
Objective To analyze clinical and genetic risk factors of refractory or relapsed acute myeloid leukemia (AML) patients,and evaluate the efficacy of reinduction of chemotherapy.Methods 296 newly diagnosed AML patients,including 89 refractory or relapsed cases,were observed with clinical characteristics.And the efficiency of different reinduction chemotherapy regimens were compared.Results Compared with the non-refractory or relapsed AML,age,complex karyotype and Fms like tyrosine kinase 3 internal tandem duplication (FLT3-ITD) gene mutations were risk factors of relapsed or refractory AML (P ＜ 0.05).Seventy-eight refractory and relapsed AML patients received reinduction therapy.The overall response rate (the complete response rate and the partial response rate) was 44.90 ％ (30/78).All reinduction regimens were divided into three categories:using the initial induction scheme or using new induction scheme including some chemotherapeutics without cross-resistance (regimen A),using the induction regimen containing medium-or high-dose cytarabine (regimen B),and using priming regimen containing of G-CSF,cytarabine,aclacinomycin or homoharringtonine (regimen C).Their overall response rate were 35.12 ％ (13/37),61.90 ％ (13/21) and 45.00 ％ (9/20),respectively,in which the overall response rate of regimen B was statistically higher than regimen A (P ＜ 0.05).Conclusions Age,complex karyotype and FLT3-ITD mutation were important causes of relapsed or refractory AML.The overall response rates were different among three different reinduction regimens.It is helpful to improve the overall response rate of reinduction therapy to use the regimen containing medium-or high-dose cytarabine,which was more suitable for young patients.For patients with poor tolerance,the priming regimen suit was more helpful to improve the overall response rate.