-
摘要: 目的:探讨老年急性髓系白血病(AML)患者表观遗传学调控基因TET2、IDH1突变的发生率,并了解其临床特征。方法:采用基因组DNA-PCR方法扩增TET2、IDH1基因外显子,基因测序来分析其基因突变,同时检测NPM1、FLT3-TKD、FLT3-ITD、C-KIT、CEPBA、JAK2V617及MLL-PTD突变情况,随访判定其疗效。结果:50例老年AML(非APL)患者中,12例患者检测到TET2基因突变,8例患者检测到IDH1基因突变,19例(38%)患者检测到至少一种表观遗传学调控基因的突变。TET2及IDH1基因突变与NPM1基因突变有一定的相关性。TET2、IDH1基因突变易发于正常核型的老年AML患者中,在25例正常核型的老年AML患者中,发生TET2或IDH1基因突变为13例,发生率为52.0%(P<0.05)。老年AML患者加用去甲基药物联合化疗可能有较高的完全缓解率。结论:在老年AML患者中,TET2和IDH1两种基因突变较为常见,尤其在正常核型的老年AML中,TET2、IDH1基因突变与患者的临床特点、疗效有一定相关性,对指导老年AML的个体化治疗有一定的意义。Abstract: Objective: To investigate the incidence of TET2 and IDH1 mutations in elderly patients with acute myeloid leukemia(AML).Methods: TET2 and IDH1 exons were amplified by genomic DNA-PCR, and their gene mutations were analyzed by gene sequencing. NPM1, FLT3-TKD, FLT3-ITD, C-KIT, CEPBA, JAK2 V617 F and MLL-PTD mutations were detected at the same time.Results: Among the 50 elderly AML(non-APL) patients, TET2 gene mutations were detected in 12 patients, IDH1 gene mutations were detected in 8 patients, and at least one epigenetic regulatory gene mutation was detected in 19 patients(38%). In addition, TET2 and IDH1 gene mutations were prone to occur in elderly AML patients with normal karyotype. Among 25 patients with normal karyotypes, TET2 or IDH1 gene mutations occurred in 13 cases, with an incidence of 52.0%(P<0.05). Elderly AML patients with demethylation drugs combined with chemotherapy may have a higher complete remission rate.Conclusion: TET2 and IDH1 gene mutations are common in elderly patients with AML, especially in elderly patients with normal karyotype. The mutation of DNA methylation regulation gene is related to clinical characteristics and curative effect of patients, which has certain significance for guiding the individual chemotherapy of elderly AML.
-
Key words:
- elderly acute myeloid leukemia /
- epigenetics /
- TET2 gene /
- IDH1 gene /
- DNA mutation /
- curative effect
-
[1] Wouters BJ,Delwel R.Epigenetics and approaches to targeted epigenetic therapy in acute myeloid leukemia[J].Blood,2016,127(1):42-52.
[2] Bullinger L,Dhner K,Dhner H.Genomics of acute myeloid leukemia diagnosis and pathways[J].J Clin Oncol,2017,35(9):934-946.
[3] Lin PH,Li HY,Fan SC,et al.A targeted next-generation sequencing in the molecular risk stratification of adult acute myeloid leukemia:implications for clinical practice[J].Cancer Med,2017,6(2):349-360.
[4] Ashwin K,Ross LL,Aaron DV.Driver mutations in acute myeloid leukemia[J].Curr Opin Hematol,2020,27(2):49-57.
[5] Zjablovskaja,Florian.Acute Myeloid Leukemia:Aging and Epigenetics[J].Cancers,2019,12(1):103.
[6] Prassek VV,Rothenberg-Thurley M,Sauerland MC,et al.Genetics of acute myeloid leukemia in the elderly:Mutation spectrum and clinical impact in intensively treated patients aged 75 years or older[J].Haematologica,2018,103(11):1853-1861.
[7] Zhang M,Yin J,He Q,et al.Chinese and Europeans with acute myeloid leukemia have discordant mutation topographies[J].Leuk Res,2018,70:8-12.
[8] Silva P,Neumann M,Schroeder MP,et al.Acute myeloid leukemia in the elderly is characterized by a distinct genetic and epigenetic landscape[J].Leukemia,2017,31(7),1640-1644.
[9] Ponciano-Gómez A,Martínez-Tovar A,Vela-Ojeda J,et al.Mutations in TET2 and DNMT3A genes are associated with Changes in global and gene-specific methylation in acute myeloid leukemia[J].Tumour Biol,2017,39(10):1010428317732181.
[10] 李秋柏,吴迪.老年急性髓系白血病去甲基化药物治疗新进展[J].临床血液学杂志,2020,33(5):307-311.
[11] Xu Q,Li Y,Jing Y,et al.Epigenetic modifier gene mutations-positive AML patients with intermediate-risk karyotypes benefit from decitabine with CAG regimen[J].Int J Cancer,2020,146(5):1457-1467.
[12] Sasaki K,Kanagal-Shamanna R,Montalban-Bravo G,et al.Impact of the variant allele frequency of ASXL1,DNMT3A,JAK2,TET2,TP53,and NPM1 on the outcomes of patients with newly diagnosed acute myeloid leukemia[J].Cancer,2020,126(4):765-774.
[13] Jing CB,Fu C,Prutsch N,et al.Synthetic lethal targeting of TET2-mutant hematopoietic stem and progenitor cells(HSPCs)with TOP1-targeted drugs and PARP1 inhibitors[J].Leukemia,2020,34(11):2992-3006.
[14] Hiller JK,Schmoor C,Gaidzik VI,et al.Evaluating the impact of genetic and epigenetic aberrations on survival and response in acute myeloid leukemia patients receiving epigenetic therapy[J].Ann Hematol,2017,96(4):559-565.
[15] Oliva EN,Candoni A,Salutari P,et al.Azacitidine for Post-Remission Therapy in Elderly Patients with Acute Myeloid Leukemia:Final Results of the Qoless AZA-Amle Randomized Trial[J].Blood,2019,134:117.
[16] Dexheimer GM,Alves J,Reckziegel L,et al.DNA Methylation Events as Markers for Diagnosis and Management of Acute Myeloid Leukemia and Myelodysplastic Syndrome[J].Dis Markers,2017,2017:5472893.
[17] Wang H,Li Y,Lv N,et al.Predictors of clinical responses to hypomethylating agents in acute myeloid leukemia or myelodysplastic syndromes[J].Ann Hematol,2018,97(11):2025-2038.
计量
- 文章访问数: 735
- PDF下载数: 309
- 施引文献: 0