本文關(guān)鍵詞： 急性髓系白血病 AML1-ETO融合基因 微小殘留病 兒童 預(yù)后　出處：《鄭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討動(dòng)態(tài)監(jiān)測(cè)AML1-ETO轉(zhuǎn)錄本水平在兒童t(8;21)急性髓系白血病(AML)預(yù)后評(píng)估中的價(jià)值。方法以2010年1月至2016年4月就診于鄭州大學(xué)人民醫(yī)院的55例兒童t(8;21)AML患者為研究對(duì)象,應(yīng)用實(shí)時(shí)定量PCR(RQ-PCR)技術(shù)動(dòng)態(tài)監(jiān)測(cè)患者的AML1-ETO轉(zhuǎn)錄本水平,分析其變化與疾病預(yù)后的關(guān)系。結(jié)果初診時(shí)患者骨髓細(xì)胞中的AML1-ETO轉(zhuǎn)錄本水平與復(fù)發(fā)和預(yù)后無關(guān)。1個(gè)療程誘導(dǎo)緩解治療后,骨髓細(xì)胞中AML1-ETO轉(zhuǎn)錄本水平比診斷時(shí)下降大于2個(gè)對(duì)數(shù)級(jí)(a2 Log)者,與a2 Log者相比,5年累積復(fù)發(fā)率(CIR)分別為(24.3±8.4)%和(52.6±9.7)%(P=0.003);5年無復(fù)發(fā)生存(RFS)率分別為(71.6±12.7)%和(48.1±13.2)%(P=0.016);5年總生存(OS)率分別為(76.9±12.5)%和(48.9±14.7)%(P=0.012),差異均具有統(tǒng)計(jì)學(xué)意義;多因素Cox回歸顯示,1療程誘導(dǎo)緩解后的AML1-ETO轉(zhuǎn)錄本下降是否大于2個(gè)對(duì)數(shù)級(jí),是影響RFS、OS的獨(dú)立預(yù)后因素(P0.05)。鞏固治療及治療結(jié)束隨訪期間,連續(xù)動(dòng)態(tài)監(jiān)測(cè)AML1-ETO轉(zhuǎn)錄本水平變化,患者從分子學(xué)復(fù)發(fā)至血液學(xué)復(fù)發(fā)的中位時(shí)間為4個(gè)月。對(duì)2例分子學(xué)復(fù)發(fā)后的患者,及時(shí)采取異基因造血干細(xì)胞移植(allo-HSCT)治療后,未發(fā)生血液學(xué)復(fù)發(fā)。結(jié)論通過RQ-PCR技術(shù),連續(xù)動(dòng)態(tài)監(jiān)測(cè)兒童t(8;21)AML患者的AML1-ETO轉(zhuǎn)錄本水平,可以將兒童t(8;21)AML細(xì)分為相對(duì)低危組和相對(duì)高危組,早期識(shí)別出復(fù)發(fā)風(fēng)險(xiǎn)高的患者,為實(shí)現(xiàn)兒童t(8;21)AML的精準(zhǔn)分層和風(fēng)險(xiǎn)-適應(yīng)治療提供科學(xué)依據(jù)。
[Abstract]:Objective to investigate the dynamic monitoring of AML1-ETO transcripts in children. 21) the prognostic value of acute myeloid leukemia (AML). Methods 55 cases of children with acute myeloid leukemia from January 2010 to April 2016 were treated at Renmin Hospital of Zhengzhou University. The AML1-ETO transcripts of 21AML patients were dynamically monitored by real-time quantitative PCRQ-PCRR technique. Results the level of AML1-ETO transcripts in bone marrow cells was not related to recurrence and prognosis. The levels of AML1-ETO transcripts in bone marrow cells decreased more than two logarithmic levels of A2Logs compared with those of A2 Log patients. The 5-year cumulative recurrence rate (CIRR) was 24.3 鹵8.4% and 52.6 鹵9.7%, respectively. The RFS rates of 5-year recurrence free survival were 71.6 鹵12.7% and 48.1 鹵13.2respectively. The total survival rate in 5 years was 76.9 鹵12.5% and 48.9 鹵14.7%, respectively. The difference was statistically significant. Multivariate Cox regression analysis showed whether the decrease of AML1-ETO transcripts was greater than two logarithmic levels after remission induced by one course of treatment, which was related to RFS. The independent prognostic factor of OS was P0.05.The changes of AML1-ETO transcripts were continuously monitored during the follow-up period of consolidation therapy and treatment. The median time from molecular recurrence to hematological recurrence was 4 months. After allogeneic hematopoietic stem cell transplantation (allo-HSCT), two patients were treated with allo-HSCT. There was no hematological recurrence. Conclusion the RQ-PCR technique was used to continuously monitor t0 8 in children. The AML1-ETO transcripts of 21 AML patients can be transformed into t0 8 in children; 21 AML was subdivided into relatively low risk group and relatively high risk group. Accurate stratification and risk-adaptation therapy of 21 AML provide scientific basis.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R733.71

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本文編號(hào)：1493757