一个伴CEBPA基因突变的急性髓系白血病家系调查及临床分析

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目的:探讨伴CEBPA基因突变的家族性急性髓系白血病(AML)的临床特征、病因及转归,提高对家族性白血病的认识。方法:调查一个伴CEBPA基因突变AML家系患者的发病年龄、临床特征、转归及预后并绘制家系谱。对先证者采集骨髓及口腔黏膜细胞,与先证者有血缘关系的亲属,采集外周血,通过基因测序技术检测基因突变。结果:该家系共有10人诊断为AML,其中男4例,女6例,中位年龄9(3~48)岁。10例患者中,6例死亡,其中4例未进行治疗,1例患者化疗后生存3年复发死亡,1例采取中药及支持治疗生存2年后死亡。4例患者生存,1例接受化疗患者生存达15年,3例患者接受化疗联合造血干细胞移植,至随访截止,生存时间分别为6、9、28个月。对先证者及8名与先证者有血缘关系的亲属进行基因测序,发现5例存在胚系CEBPA TAD p.G36Afs*124突变,其中4例确诊为AML,1例随访至今未发病。结论:伴CEBPA基因突变的家族性AML多在儿童及青壮年期发病,具有完全或接近完全的外显率,通过积极治疗,大多预后良好。“,”Objective:To investigate the clinical characteristics, etiology, and prognosis of familial acute myeloid leukemia (AML) with germline CEBPA mutation and improve the understanding of familial leukemia.Methods:The age of onset, clinical characteristics, outcome, and prognosis of a family of patients with AML were investigated, and the family tree of the cases was displayed. Bone marrow and oral mucosal cells were collected from the proband, and peripheral blood was collected from the relatives of the proband. Gene mutation was detected by gene sequencing technology.Results:A total of 10 patients in this family were diagnosed with acute leukemia, including 4 males and 6 females, with a median age of 9 (3-48) years. Of the 10 patients, six died. Among them, 4 patients did not receive treatment, 1 patient survived 3 years after chemotherapy and died of relapse, and one patient died 2 years after receiving traditional Chinese medicine and supportive treatment. Four patients are alive. One patient has survived 15 years through chemotherapy, and three patients have survived with chemotherapy combined with hematopoietic stem cell transplantation, and the survival time was 6, 9, and 28 months at the end of follow-up. Gene sequencing was performed on proband and 8 relatives of the proband, and 5 were found to have the germline CEBPA TAD p.G36Afs*124 mutation. Among the 5 individuals with confirmed CEBPA mutation, 4 were diagnosed with AML, and 1 had not developed disease during follow-up.Conclusion:AML with germline CEBPA gene mutation mostly occurs in children and young adults, with complete or nearly complete penetrance. With active treatment, most of the patients have a favorable prognosis.
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