本文關(guān)鍵詞： FLT3-ITD基因突變 急性髓系白血病 異基因造血干細(xì)胞移植 預(yù)后 Meta分析　出處：《山西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:FLT3-ITD突變作為AML患者預(yù)后不良因素已成為共識(shí),然而目前對于FLT3-ITD突變對接受異基因造血干細(xì)胞移植的AML患者預(yù)后影響仍有爭議,本課題采用Meta分析的方法評價(jià)FLT3-ITD突變對接受異基因造血干細(xì)胞移植的AML患者預(yù)后的影響。方法:以“FLT3”和“hematopoietic transplantation”或“FLT3”和“allogeneic transplantation”為檢索詞,檢索Pubmed、Cochrane、Highwire數(shù)據(jù)庫,以“FLT3”和“造血干細(xì)胞移植”或“FLT3”和“異基因移植”為檢索主題詞,檢索相關(guān)期刊論文、萬方數(shù)據(jù)庫,檢索所有收錄的關(guān)于FLT3-ITD突變與接受異基因造血干細(xì)胞移植的AML患者預(yù)后關(guān)系的文獻(xiàn),檢索年限均為從建庫至2016年10月31日。以預(yù)后相關(guān)指標(biāo)無病生存率、總生存率、復(fù)發(fā)率、非復(fù)發(fā)死亡率為評價(jià)指標(biāo)。采用RevMan5.3軟件進(jìn)行Meta分析。結(jié)果:共納入10篇研究,合計(jì)1589例患者,其中FLT3-ITD基因突變(FLT3-ITD+)患者465例,FLT3-ITD無突變組(FLT3-ITD-)AML患者1124例。其中5篇研究包含正常染色體核型AML(NK-AML)患者,共計(jì)834例患者,其中FLT3-ITD+患者291例,FLT3-ITD-患者543例。Meta分析結(jié)果顯示:在所有入組AML患者中,FLT3-ITD+與FLT3-ITD-接受異基因造血干細(xì)胞移植的AML患者無病生存率(DFS)的風(fēng)險(xiǎn)比(HR)為1.36(95%CI:1.25~1.48,P0.00001);總生存率(OS)的風(fēng)險(xiǎn)比(HR)為1.34(95%CI:1.22~1.46,P0.00001);復(fù)發(fā)率(RR)的風(fēng)險(xiǎn)比(HR)為1.64(95%CI:1.48~1.83,P0.00001),差異均有統(tǒng)計(jì)學(xué)意義,提示FLT3-ITD突變?yōu)榻邮墚惢蛟煅杉?xì)胞移植的AML預(yù)后的危險(xiǎn)因素;非復(fù)發(fā)死亡率(NRM)的風(fēng)險(xiǎn)比(HR)為0.80(95%CI:0.37~1.7,P=0.59),差異無統(tǒng)計(jì)學(xué)意義。在NK-AML患者中,FLT3-ITD+與FLT3-ITD-的接受異基因造血干細(xì)胞移植的AML患者無病生存期率(DFS)的風(fēng)險(xiǎn)比(HR)為1.36(95%CI:1.21~1.52,P0.00001);總生存率(OS)的風(fēng)險(xiǎn)比(HR)為1.34(95%CI:1.19~1.52,P0.00001);復(fù)發(fā)率(RR)的風(fēng)險(xiǎn)比(HR)為1.61(95%CI:1.40~1.85,P0.00001),差異均有統(tǒng)計(jì)學(xué)意義,提示FLT3-ITD突變?yōu)榻邮墚惢蛟煅杉?xì)胞移植的NK-AML患者預(yù)后的危險(xiǎn)因素。結(jié)論:根據(jù)Meta分析結(jié)果,對于所有入組AML和NK-AML亞組患者,FLT3-ITD突變?yōu)榻邮墚惢蛟煅杉?xì)胞移植的AML患者無病生存率、總生存率和復(fù)發(fā)率的危險(xiǎn)因素;對于所有入組AML患者,FLT3-ITD對接受異基因造血干細(xì)胞移植的AML患者非復(fù)發(fā)死亡率無明顯影響。該研究結(jié)果提示FLT3-ITD突變?yōu)榻邮墚惢蛟煅杉?xì)胞移植的AML患者的一個(gè)預(yù)后不良因素。由于納入文獻(xiàn)數(shù)量、質(zhì)量等差異,還需進(jìn)一步研究。
[Abstract]:Objective it has been agreed that the FLT3-ITD mutation is a poor prognostic factor in patients with AML. However, there is still controversy about the effect of FLT3-ITD mutation on the prognosis of AML patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). In this study, Meta analysis was used to evaluate the effect of FLT3-ITD mutation on the prognosis of AML patients undergoing allogeneic hematopoietic stem cell transplantation. Methods: using "FLT3" and "hematopoietic transplantation" or "FLT3" and "allogeneic transplantation" as the key words, the Pubmedan Cochrane High wire database was searched. "FLT3" and "Hematopoietic stem cell transplantation" or "FLT3" and "allogeneic transplantation" were used to search the full text database of Chinese periodicals and Wanfang database. All the literatures about the relationship between FLT3-ITD mutation and the prognosis of AML patients undergoing allogeneic hematopoietic stem cell transplantation were searched. The searching period was from the establishment of the library to October 31st 2016. The disease-free survival rate, overall survival rate and recurrence rate were determined by the prognostic markers, such as disease-free survival rate, overall survival rate and recurrence rate. RevMan5.3 software was used for Meta analysis. Results: a total of 10 studies were conducted, and 1 589 patients were included in the study. There were 465 patients with FLT3-ITD gene mutation FLT3-ITD and 1124 patients with FLT3-ITD-AML without FLT3-ITD mutation. Among 291 FLT3-ITD patients with FLT3-ITD- 543 patients with FLT3-ITD-, the results of Meta-analysis showed that the risk ratio of FLT3-ITD and FLT3-ITD- AML patients receiving allogeneic hematopoietic stem cell transplantation (AML) was 1.36 鹵95% CI 1.251.48P0.00001; the overall survival rate was higher than that of OS). The risk ratio of the recurrence rate (RR) is 1.64% 95% CI: 1.48% 1.88% 1.83% P 0.00001%, the difference is statistically significant. The results suggest that FLT3-ITD mutation is a risk factor for the prognosis of AML after allogeneic hematopoietic stem cell transplantation (HSCT). There was no significant difference in the risk of NK-AML patients with FLT3-ITD and FLT3-ITD- in AML patients receiving allogeneic hematopoietic stem cell transplantation. The risk ratio of FLT3-ITD and FLT3-ITD- was 1.3695 CI: 1.21% 1.21% 1.21% (P 0.00001); the risk of overall survival in patients with NK-AML was 1.3695% CI: 1.21% 1.21% 1.21% (P 0.00001); the risk of overall survival in patients with AML receiving allogeneic hematopoietic stem cell transplantation was 1.3695 CI: 1.21% 1.21%, P 0.00001; overall survival rate of AML patients receiving allogeneic hematopoietic stem cell transplantation (FLT3-ITD-). Compared with HR1.34 / 95 CI: 1.19 / 1.52 / P 0.00001; the risk of recurrence rate / RR is 1.61/ 95 / 1.401.85 / P 0.00001, respectively. The difference is statistically significant. The results suggest that FLT3-ITD mutation is a risk factor for the prognosis of NK-AML patients receiving allogeneic hematopoietic stem cell transplantation. Conclusion: according to the results of Meta analysis, The risk factors of disease-free survival, overall survival rate and recurrence rate of AML patients undergoing allogeneic hematopoietic stem cell transplantation with FLT3-ITD mutation in all subgroups of AML and NK-AML. FLT3-ITD had no significant effect on the non-recurrence mortality of AML patients receiving allogeneic hematopoietic stem cell transplantation (HSCT) for all AML patients. The results of this study suggest that FLT3-ITD mutation is a preconditioning of AML patients receiving allogeneic hematopoietic stem cell transplantation (HSCT). Due to the number of documents included, The difference in quality needs further study.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R733.71

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本文編號：1505298