Abstract
This study aims to explore the effect of the ITI (interferon alpha-1b, thalidomide, and interleukin-2) regimen on the AML1-ETO fusion gene in patients with t(8;21) acute myeloid leukemia (AML) who were in hematologic remission but positive for the AML1-ETO fusion gene. From September 2014 to November 2020; 20 patients with AML (15 from The Affiliated Cancer Hospital of Zhengzhou University, 4 from The First Affiliated Hospital; and College of Clinical Medicine of Henan University of Science and Technology, and 1 from Anyang District Hospital) with hematological remission but AML1-ETO fusion gene positivity were treated with different doses of the ITI regimen to monitor changes in AML1-ETO fusion gene levels. Twenty patients were treated with a routine dose of the ITI regimen, including 13 males and 7 females. The median patient age was 38 (14–70 years). The fusion gene was negative in 10 patients after 1 (0.5 ~ 8.6) month, significantly decreased in 4 patients after 2.8 (1 ~ 6) months, increased in 4 patients, and unchanged in 2 patients. The 4 patients with elevated levels of the fusion gene were treated with an increased dose of the ITI regimen, and all four patients became negative, for a total effective rate of 90%. The ITI regimen reduces AML1-ETO fusion gene levels in patients with AML who are in hematologic remission but are fusion gene–positive. Improvement was observed in patients’ response to a higher dose administration, and patients tolerated the treatment well.
Highlights
At present, acute myeloid leukemia (AML) prognosis stratification is primarily performed according to cytogenetics and molecular biology [1], but with the improvement of detection methods, minimal residual disease (MRD) has become an independent prognostic factor for AML [2]
No leukemia cells were found in the bone marrow, and MRD was negative by 10-color flow cytometry
Recurrence refers to the proportion of blast cells in bone marrow or peripheral blood ≥ 0.05, but the number of cells examined by morphological examination is relatively small (200,500) and is greatly affected by bone marrow puncture and smear quality, which is related to the experience of the assessor [6]
Summary
Acute myeloid leukemia (AML) prognosis stratification is primarily performed according to cytogenetics and molecular biology [1], but with the improvement of detection methods, minimal residual disease (MRD) has become an independent prognostic factor for AML [2]. The prognosis of patients with AML with t(8;21) chromosome abnormality, known as the AML1-ETO fusion gene, is relatively good, but clinically, the prognosis of these patients is heterogeneous: some patients cannot achieve AML1-ETO fusion gene negativity, or the fusion gene becomes positive again after
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