CD19 combined with KITD816 for optimization of prognostic stratification of t(8; 21) acute myeloid leukemia

Abstract

Objective To analyze the heterogeneity of remission and prognosis of patients with t(8; 21) acute myeloid leukemia (AML) under current treatment modalities, and to provide a basis for further risk-adapted treatment. Methods A total of 107 adult patients with primary t(8; 21) AML treated with the standard 3+ 7 regimen at Changzhou First People's Hospital from October 2014 to September 2018 were collected. The complete remission (CR) rate, cumulative incidence of relapse, event-free survival (EFS), and overall survival (OS) were evaluated by combining the characteristics of traditional Morphology, Immunology, Cytogenetics, and Molecular biology (MICM) and genetic mutations based on next-generation sequencing (NGS) using multivariate Logistic and Cox regression analyses. Results After a single induction course, the CR rate was 79.0% (83/105) and the early mortality rate was 1.9% (2/107). Multivariate analysis showed that positive KIT-D816mut was the only independent factor adversely affecting the CR rate (hazard ratio [HR]=3.29 [1.18-9.24], P=0.023), EFS (HR=3.53 [1.82-6.84], P=0.000), and OS (HR=5.45 [1.77-16.84], P=0.003). Negative CD19 expression was the only independent predictor of increased cumulative incidence of relapse (HR=0.32 [0.10-1.00], P=0.050). KITmut, KIT-N822, and complex karyotype were not independent risk factors for all endpoints. Conclusions It is suggested that the specific KIT-D816mut, rather than general KITmut, should be included in the risk stratification system of t(8; 21) AML. Patients with negative CD19 have an increased risk of relapse, which requires close monitoring. Key words: t(8; 21); Acute myeloid leukemia; CD19; Next-generation sequencing; KIT; Prognosis