Correlation Analysis and Prognostic Impacts of Biological Characteristics in Elderly Patients with Acute Myeloid Leukemia

Abstract

Background

The significant heterogeneity of elderly AML patients’ biological features has caused stratification difficulties and adverse prognosis. This paper did a correlation study between their genetic mutations, clinical features, and prognosis to further stratify them.

Methods

90 newly diagnosed elderly acute myeloid leukemia (AML) patients (aged ≥60 years) who detected genetic mutations by next-generation sequencing (NGS) were enrolled between April 2015 and March 2021 in our medical center.

Results

A total of 29 genetic mutations were identified in 82 patients among 90 cases with a frequency of 91.1%. DNMT3A, BCOR, U2AF1, and BCORL1 mutations were unevenly distributed among different FAB classifications (p < 0.05). DNMT3A, IDH2, NPM1, FLT3-ITD, ASXL1, IDH1, SRSF2, BCOR, NRAS, RUNX1, U2AF1, MPO, and WT1 mutations were distributed differently when an immunophenotype was expressed or not expressed (p<0.05). NPM1 and FLT3-ITD had higher mutation frequencies in patients with normal chromosome karyotypes than abnormal chromosome karyotypes (p<0.001, p=0.005). DNMT3A and NRAS mutations predicted lower CR rates. DNMT3A, TP53, and U2AF1 mutations were related to unfavorable OS. TET2 mutation with CD123+, CD11b+ or CD34- predicted lower CR rate. IDH2+/CD34- predicted lower CR rate. ASXL1+/CD38+ and SRSF2+/CD123- predicted shorter OS.

Conclusion

The study showed specific correlations between elderly AML patients’ genetic mutations and clinical features, some of which may impact prognosis.

Keywords:

• elderly AML
• genetic mutation
• FAB subtype
• karyotype
• immunophenotype
• prognosis

Data Sharing Statement

The datasets used and analyzed in this study are available from the corresponding authors upon reasonable request.

Ethics Approval and Informed Consent

This study was approved, and the written informed consent was waived by the ethics committee of the first affiliated hospital of University of Science and Technology of China (2022-RE-064) due to the retrospective nature of the review, and confirmed that the data was anonymized and maintained with confidentiality. The study was conducted in accordance with the Declaration of Helsinki.

Acknowledgments

The authors thank the patients, their families, and all doctors who treated the patients.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was supported by the Key Research and Development Program Project of Anhui Province [No. 201904a07020102], the National Natural Science Foundation of China [No. 81600107] and the Anhui Provincial Natural Science Foundation [No. 1708085MH180].