验证 2017 年欧洲白血病网络分类与 NPM1 和 FLT3 内部串联重复基因型的急性髓系白血病。
Validation of the 2017 European LeukemiaNet classification for acute myeloid leukemia with NPM1 and FLT3-internal tandem duplication genotypes.
机构信息
Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas.
出版信息
Cancer. 2019 Apr 1;125(7):1091-1100. doi: 10.1002/cncr.31885. Epub 2018 Dec 6.
BACKGROUND
The revised 2017 European LeukemiaNet (ELN) classification (ELN-2017) of acute myeloid leukemia (AML) divides patients into 3 prognostic risk categories, with additional factors such as the fms-like tyrosine kinase 3 (FLT3)-internal tandem duplication (ITD) allele ratio (AR) considered for risk stratification. To the best of the authors' knowledge, the prognostic usefulness of ELN-2017 in comparison with ELN-2010 in younger patients with AML has not been validated to date.
METHODS
The authors performed a retrospective study on patients aged <60 years who received idarubicin plus cytarabine (IA)-based induction chemotherapy for newly diagnosed AML.
RESULTS
According to ELN-2017 criteria, the number of patients in the favorable (Fav), intermediate (Int), and adverse (Adv) risk categories was 192 patients (27%), 331 patients (46%), and 192 patients (27%), respectively. Overall survival probabilities at 5 years in the Fav, Int, and Adv groups were 57%, 37%, and 18%, respectively. In comparison, the 5-year overall survival probabilities in the Fav (169 patients), intermediate (IR)-1 (80 patients), IR-2 (306 patients), and Adv (160 patients) ELN-2010 categories were 59%, 32%, 40%, and 14%, respectively. Although ELN-2010 historically distinguishes prognosis into IR-1 and IR-2 categories in younger patients, this difference was nullified in the current study cohort. When comparing patients with a low FLT3-ITD AR with those with a high FLT3-ITD AR, no significant differences in survival were noted among patients with nucleophosmin 1 (NPM1)-mutated AML (P = .28) or wild-type NPM1 (P = .35), and in those treated with IA alone (P = .79) or those treated with IA and a FLT3 inhibitor (P = .10).
CONCLUSIONS
The ELN-2017 more accurately distinguishes prognosis in patients with newly diagnosed AML. The lack of prognostic significance for the FLT3-ITD AR needs further evaluation in different treatment settings.
背景
修订后的 2017 年欧洲白血病网络（ELN）急性髓系白血病（AML）分类（ELN-2017）将患者分为 3 个预后风险类别，对于风险分层，还考虑了 fms 样酪氨酸激酶 3（FLT3）-内部串联重复（ITD）等位基因比（AR）等附加因素。据作者所知，ELN-2017 与 ELN-2010 在年轻 AML 患者中的预后比较尚未得到验证。
方法
作者对接受伊达比星联合阿糖胞苷（IA）诱导化疗的新诊断 AML 年龄<60 岁的患者进行了回顾性研究。
结果
根据 ELN-2017 标准，有利（Fav）、中间（Int）和不利（Adv）风险类别的患者数量分别为 192 例（27%）、331 例（46%）和 192 例（27%）。Fav、Int 和 Adv 组的 5 年总生存率分别为 57%、37%和 18%。相比之下，Fav（169 例）、中间（IR-1）（80 例）、IR-2（306 例）和 Adv（160 例）ELN-2010 类别的 5 年总生存率分别为 59%、32%、40%和 14%。尽管 ELN-2010 历史上在年轻患者中区分预后为 IR-1 和 IR-2 类别，但在本研究队列中，这种差异被消除了。当比较 FLT3-ITD AR 低的患者与 FLT3-ITD AR 高的患者时，在 NPM1 突变 AML（P=.28）或野生型 NPM1（P=.35）患者以及单独接受 IA 治疗的患者（P=.79）或接受 IA 和 FLT3 抑制剂治疗的患者（P=.10）中，无生存差异。
结论
ELN-2017 更准确地区分了新诊断 AML 患者的预后。FLT3-ITD AR 缺乏预后意义，需要在不同的治疗环境中进一步评估。
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