Mutational Spectrum and Prognosis Analysis of AML Patients Based on High-Throughput Sequencing

Objective: To investigate the mutational spectrum and its prognostic significance in patients with acute myeloid leukemia (AML).

Methods: The clinical data of 93 patients with newly diagnosed AML who underwent gene mutation detection by high-throughput sequencing (HTS) from March 2014 to April 2018 in our hospital was analyzed retrospectively. The distribution of mutant genes was summarized and the prognostic factors for intermediate-risk acute myeloid leukemia (IR-AML) were analyzed.

Results: Among 93 AML patients, 88.17% had at least one gene mutation, and 53.76% patients showed more than one recurrent genetic mutation. CEBPA showed the highest mutation frequency (20.4%), followed by ASXL1, TET2, NRAS, FLT3-ITD, NPM1, IDH2, DNMT3A, and their mutation frequency were higher than 10%. IDH1/2 and NPM1, ASXL1 and U2AF1, FLT3 and NPM1 often co-occured (P < 0.05). In the prognosis analysis of 57 patients with IR-AML, the IDH2 mutation related with poor overall survival (OS) and progression-free survival (PFS) (P < 0.05). The prognosis analysis of IR-AML patients showed that age≥50 years, WBC >100×109/L, anemia, and CD22+ were independent risk factors for OS. Age≥50 years , WBC >100×109/L, anemia, CD34+, IDH2 mutation were independent risk factors for PFS.

Conclusions: There are co-occurring mutation patterns between the mutated genes. IDH2 mutations relates with poor prognosis and possesses potential to be molecules for model of IR-AML prognostic stratification. Genetic testing based on HTS contributes to revealing the pathogenic mechanism of AML, and is significant for evaluating the prognosis of patients with AML.