骨髓增生异常性肿瘤向急性髓系白血病转化的影响因素及预后分析OA

Objective To investigate the influencing factors for leukemic transformation to acute mye-loid leukemia(AML)in patients with myelodysplastic syndromes(MDS),and to evaluate their impact on the prognosis.Methods A retrospective analysis was conducted on the clinical data of 281 patients diagnosed with MDS at The Affiliated Hospital of Guizhou Medical University from April 2015 to June 2023.The patients were divided into the transformation to AML group(n=84)and the non-transformation to AML group(n=197)based on whether they developed AML during the follow-up period.Laboratory data,gene mutations,and chromosomal abnormalities results of both groups were collected.Stepwise logistic regression analysis was used to identify the risk factors for MDS transformation to AML,and the Kaplan-Meier method was employed for survival analysis.The Cox regression model was used to evaluate the influencing factors of prognosis.Re-sults Compared with the non-transformation group,the age of the transformation group was larger[(64.05±14.90)years vs.(59.32±15.89)years],the degree of bone marrow fibrosis,the rate of gene muta-tions(57.1%vs.31.0%),the rate of chromosomal abnormalities(54.8%vs.27.4%),the high-risk(31.0%vs.19.3%)and extremely high-risk(27.3%vs.7.6%)proportions of international prognostic sco-ring system-revised(IPSS-R)risk grades,and the IPSS-R score(3.87±1.52 vs.2.91±1.43)were higher,the differences were statistically significant(P<0.05).The results of multivariate logistic regression analysis showed that gene mutations,RUNX1 mutations,chromosomal abnormalities,trisomy 8,IPSS-R grade and score were independent influencing factors for MDS transformation to AML(P<0.05).The median overall survival(OS)time of the transformation group was significantly shorter than that of the non-transformation group(17.58 months vs.58.31 months,P<0.05).The results of Cox regression model analysis showed that age,transformation status,gene mutations,RUNX1 mutations,trisomy 8,extremely high-risk IPSS-R grade,and IPSS-R score were independent influencing factors for OS time(P<0.05).Conclusion The transforma-tion of MDS to AML indicates a very poor survival outcome,while RUNX1 mutations,trisomy 8 and IPSS-R score are common independent influencing factors for both the transformation and prognosis.