中国生物工程杂志

Objective: To investigate the clinical significance of the expression level of programmed death molecule 1 ligand 1 (PD-L1) in the occurrence, transformation, and treatment of acute myeloid leukemia (AML). Methods: First, using GEO software and GEO2R calculation method, with P<0.05 and | logFC |>1 as conditions, we analyzed the expression of common immune monitoring points in public databases. The data were analyzed using TCGA-LAML queue data and survival R packets for high expression PD-L1 patients. Second, we selected newly diagnosed AML patients in our department from October 2017 to March 2023 to verify our hypothesis. Flow cytometry was used to detect the expression levels of PD-L1 in the bone marrow T lymphocyte programmed cell death receptor 1 (PD-1) and CD34⁺progenitor cells before treatment. The correlation between PD-1 and PD-L1 expression levels and patient clinical characteristics, efficacy, and survival was analyzed. Results: The expression of lymphocyte activation gene 3 (LAG3), PD-1, PD-L1, and T cell immunoglobulin domain and mucin domain-3 (TIM3) at immune checkpoint in the initially diagnosed AML patients was higher than that in normal individuals (P<0.05), and the survival rate was higher in the group with low PD-L1 expression at initial diagnosis. Recurrent and refractory AML and secondary AML have higher levels of PD-L1 expression at initial diagnosis. The high expression of PD-L1 in newly diagnosed AML patients tends to have complex chromosomal karyotypes, poorer prognosis, and shorter survival. Conclusions: The PD-1/PD-L1 signaling pathway may be involved in the immune escape mechanism of myeloid tumor cells, and its expression level is positively correlated with the malignancy and progression of the disease, while negatively correlated with treatment efficacy and survival.