The value of chromosomal findings in treatment of acute myeloid leukemia

Abstract

U istraživanje je uključeno 536 bolesnika s novootkrivenom akutnom mijeloičnom leukemijom. Medijan dobi iznosio je 36 godine u rasponu od 16-60 godina. Akutna mijeloična leukemija M2 podtipa dijagnosticirana je u 31% slučajeva, dok je AML-M6 dijagnosticirana u 3% slučajeva. Akutna promijelocitna leukemija dijagnosticirana je u 76/536 (14%). Akutna mijeloična leukemija M4 podtipa dijagnosticirana je u 75/536 (14%), dok je AML-M5 dijagnosticirana u 62/536 (12%) bolesnika. Eritroleukemija (AML-M6) dijagnosticirana je u 18/536 (3%) bolesnika. Medijan leukocita pri dijagnozi iznosio je 19x109/L, raspona od 0.8-323x109/L. Za analizu kromosoma primjenjene su standardne metode pruganja. Prema nalazu citogenetske analize bolesnici su razdijeljeni u tri prognostičke skupine. Bolesnici s translokacijom t(8;21), inverzijom inv(16), translokacijom t(15;17) nalaze se u tzv. povoljnoj skupini. Bolesnici s urednim nalazom bez kromosomskih promjena u kariotipu odnosno bolesnici sa citogenetskim promjenama nepoznate prognoze čine posebnu skupinu intermedijarne prognoze. Bolesnici u kojih je nađena trisomija 8, ili promjene kromosoma 5, 7, promjene lokusa 11q23, 3q26 nalaze se u nepovoljnoj skupini. Citogenetske promjene nađene su u 363 (68%) bolesnika. Povoljan citogenetski nalaz nađen je u 118 (22%) bolesnika. Intermedijarni tip citogenetske promjene utvrđen je u 260 (49%) bolesnika, dok je u 158 (30%) bolesnika utvrđena nepovoljna citogentska promjena. Kompletna remisija postignuta je u 76% bolesnika dobre citogenetske prognoze, u 70% bolesnika intermedijarne citogenetske prognoze, te u samo 45% bolesnika nepovoljne citogenetske prognoze (p=0.001). Vjerojatnost petogodišnjeg preživljenja bez znakova bolesti u bolesnika s povoljnom, intermedijarnom i nepovoljnom citogenetskom promjenom iznosi 43%, 34% i 9% (p=0.05). Vjerojatnost relapsa bolesti iznosi 82% za bolesnike s nepovoljnom citogenetskom promjenom, 68% za bolesnike s intermedijarnom citogenetskom promjenom i 56% za bolesnike s povoljnim citogenetskim nalazom (p=0.05).In our investigation 536 patients with de novo acute leukemia were included into prospective study. Median age was 36 years, ranged 16-60. The majority of patients have AML-M2 (31%) or AML-M6 subtype (3%) according to French-American-British classification. 14% patients have AML-M3 subtype. AML-M4 was observed in 75/536 (14%) and AML-M5 in 62/536 (12%) patients. In 3% patients AML-M6 was documented. Median WBC at diagnosis was 19x109/l, ranged 0.-323x109/l. For chromosome analysis standard banding was done. According to the cytogenetic finding patients were classified in three prognostic groups. Patients with translocations t(8;21) or t(15;17), inversion inv(16) were classified as a good prognostic group, while patients with trisomy 8, patients with chromosome 3, 11q23 abnormalities and patients with changes of chromosome 5 and 7 were classified as a poor prognostic group. Other patients were classified as an intermediate prognostic group. Cytogenetic abnormalities were found in 363 (68%) patients. 22% patients were classified as a good prognostic group and 158 (30%) as a poor prognosis group. Complete remission was obtained in 76% of patients with good karyotype, in 70% patients with intermediate karyotype and only 45% in poor prognostic group (P=0.001). Five year probability of disease free survival for patients with good, intermediate and poor karyotype is 43%, 34% and 9% respectively (P=0.05). Probability of relapse for patients with poor karyotype is 82%, for intermediate karyotype 68% and for patients with good karyotype is 56% (P=0.05)