Clinical and genetic features of therapy-related myeloid neoplasms after chemotherapy for acute promyelocytic leukemia
Clinical and genetic features of therapy-related myeloid neoplasms after chemotherapy for acute promyelocytic leukemia
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DOI：
10.1182/blood-2010-06-289389
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发表时间：
2010-12-23
期刊：
影响因子：
20.3
通讯作者：
Harada, Hironori
中科院分区：
文献类型：
--
作者：
Imagawa, Jun;Harada, Yuka;Harada, Hironori
急性早幼粒细胞白血病（APL）是一种高度可治愈的疾病，具有良好的完全缓解和长期生存率。然而，在成功治疗APL的患者中，治疗相关性髓系肿瘤（t-MN）的发生率越来越高。我们试图阐明t-MN和复发病例之间不同的临床特征和血液学检查结果，并确定t-MN中涉及的基因改变。我们比较了108例APL患者首次完全缓解期间发生的10例复发和11例t-MN病例。在APL诊断时，t-MN患者的白色血细胞计数低于复发患者（P = 0.048）。t-MN患者从化疗开始的总生存率显著低于复发患者（P = 0.022）。t-MN的特征为CD 34（+）/HLA-DR+，PML-RARA（-），检测到4个RUNX 1/AML 1突变。通过评估这些血液学特征，T-MN很容易与APL复发区分开来，并且它可能通过化疗诱导的RUNX 1突变起源于原始髓系细胞。（血。2010; 116（26）：6018-6022）
Acute promyelocytic leukemia (APL) is a highly curable disease with excellent complete remission and long-term survival rates. However, the development of therapy-related myeloid neoplasms (t-MN) is being reported with increasing frequency in patients successfully treated for APL. We attempted to clarify the different clinical features and hematologic findings between t-MN and relapse cases, and to identify gene alterations involved in t-MN. We compared 10 relapse and 11 t-MN cases that developed in 108 patients during their first complete remission from APL. At APL diagnosis, t-MN patients had lower white blood cell counts than did relapse patients (P = .048). Overall survival starting from chemotherapy was significantly worse in t-MN patients than in relapse patients (P = .022). The t-MN cases were characterized as CD34(+)/HLA-DR+ and PML-RARA(-), and 4 RUNX1/AML1 mutations were detected. T-MN is easily distinguished from APL relapse by evaluating these hematologic features, and it may originate from primitive myeloid cells by chemotherapy-induced RUNX1 mutations. (Blood. 2010; 116(26):6018-6022)