Long-term outcomes for unselected patients with acute myeloid leukemia categorized according to the World Health Organization classification: a single-center experience
Long-term outcomes for unselected patients with acute myeloid leukemia categorized according to the World Health Organization classification: a single-center experience
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DOI：
10.1111/j.1600-0609.2004.00397.x
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发表时间：
2005-05-01
影响因子：
3.1
通讯作者：
Naoe, T
中科院分区：
文献类型：
--
作者：
Yanada, M;Suzuki, M;Naoe, T
世界卫生组织（WHO）最近推出的急性髓系白血病（AML）新分类系统的实际效用尚未得到彻底研究。在这项研究中，我们评估了根据新的 WHO 分类进行分类的未选择的 AML 患者的长期结果。 1990 年至 2002 年间，有 109 名成人 AML 病例转诊至我院。对于整个人群，中位生存期为 1.2 年，5 年生存率为 31%。复发性遗传异常的 AML 占 26%，多系不典型增生的 AML 占 29%，治疗相关的 AML 占 13%，未分类的 AML 占可分类病例的 32%。在四组中，总生存率存在显着差异（P < 0.0001）。单变量分析显示，有六个变量影响生存：细胞遗传学风险、年龄、多系发育不良、既往化疗/放疗、治疗类型（强化或姑息治疗）和移植。然而，在多变量分析中，多系发育不良和既往化疗没有不良预后影响。检测到放射治疗（P = 0.4979 和 0.8702），而细胞遗传学风险和患者年龄保持其预后价值（P = 0.0005 和 0.0100）。这些结果表明，AML 患者的结局似乎根据 WHO 分类进行区分，但在调整细胞遗传学风险和年龄后，多系不典型增生和既往治疗的预后意义消失了。我们的研究结果表明，世界卫生组织的分类可能会通过更加重视遗传/细胞遗传学信息而得到加强。
The actual utility of a new classification system of acute myeloid leukemia (AML) recently introduced by the World Health Organization (WHO) has not been thoroughly investigated yet. In this study, we evaluated long-term outcomes of unselected AML patients categorized according to the new WHO classification. Between 1990 and 2002, 109 adult AML cases were referred to our hospital. For the entire population, the median survival duration was 1.2 yr with a 5-yr survival rate of 31%. AML with recurrent genetic abnormalities accounted for 26%, AML with multilineage dysplasia for 29%, therapy-related AML for 13%, and AML not otherwise categorized for 32% of classifiable cases. Among the four groups, a significant difference was observed in terms of overall survival (P < 0.0001). Univariate analysis showed that six variables affected survival: cytogenetic risk, age, multilineage dysplasia, prior chemo/radiotherapy, type of treatment (intensive or palliative), and transplantation. However, in multivariate analysis no adverse prognostic impact of multilineage dysplasia and prior chemo/. radiotherapy was detected (P = 0.4979 and 0.8702), whereas cytogenetic risk and patient age maintained their prognostic value (P = 0.0005 and 0.0100). These results indicate that outcomes for AML patients appear to be distinguished on the basis of the WHO classification, but the prognostic significance of multilineage dysplasia and prior therapy is lost after adjusting for cytogenetic risk and age. Our findings suggest that the WHO classification may be strengthened by greater emphasis on genetic/cytogenetic information.