Clonal evolution detected with conventional cytogenetic analysis is a potent prognostic factor in adult patients with relapsed AML
Clonal evolution detected with conventional cytogenetic analysis is a potent prognostic factor in adult patients with relapsed AML
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DOI：
10.1002/hon.2393
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发表时间：
2018-02
影响因子：
3.3
通讯作者：
H. Shimizu;A. Yokohama;T. Ishizaki;N. Hatsumi;S. Takada;T. Saitoh;T. Sakura;Y. Nojima;H. Handa
中科院分区：
文献类型：
--
作者：
H. Shimizu;A. Yokohama;T. Ishizaki;N. Hatsumi;S. Takada;T. Saitoh;T. Sakura;Y. Nojima;H. Handa
我们回顾性研究了 144 名复发性急性髓系白血病 (AML) 患者，以阐明诱发因素以及首次复发时获得额外细胞遗传学异常 (ACA) 的预后影响。其他细胞遗传学异常被认为是细胞遗传学水平上的克隆进化。 59 名患者 (41%) 在第一次复发时获得了 ACA。 ACA 获得的发生率因初始诊断时的细胞遗传学异常而异。多变量分析确定 t(8;21)、复杂核型和少于 12 个月的完全缓解持续时间是 ACA 获得的独立诱发因素。值得注意的是，与未获得 ACA 的患者相比，获得 ACA 的患者第二次完全缓解率显着较低（分别为 20.0% 和 72.5%，P < .001）。此外，首次复发后的 3 年总生存率在获得和未获得 ACA 的患者之间存在显着差异（分别为 8.5% 和 36.8%，P < .001）。多变量分析证实了这种预后意义。 ACA 获得的风险比与报道的复发 AML 患者的预后因素相似或更高。这些发现表明，在第一次复发时用传统细胞遗传学分析检测到的克隆进化会导致 AML 细胞出现严重的化疗难治性特征，在评估复发性 AML 患者的准确预后时应将其视为一个有效的预后因素。
We retrospectively investigated 144 patients with relapsed acute myeloid leukemia (AML) to clarify predisposing factors and the prognostic impact of acquisition of additional cytogenetic abnormalities (ACA) at the first relapse. Additional cytogenetic abnormalities are recognized as clonal evolution at the cytogenetic level. Fifty‐nine patients (41%) acquired ACA at the first relapse. The incidences of ACA acquisition varied depending on cytogenetic abnormalities at initial diagnosis. Multivariate analysis identified t(8;21), complex karyotype, and a duration of fewer than 12 months of complete remission as independent predisposing factors for ACA acquisition. Notably, patients with ACA acquisition showed a significantly lower second complete remission rate compared with those without ACA acquisition (20.0% vs 72.5%, respectively, P < .001). Furthermore, the 3‐year overall survival rates after the first relapse were significantly different between patients with and without ACA acquisition (8.5% vs 36.8%, respectively, P < .001). This prognostic significance was confirmed with multivariate analysis. The hazard ratio of ACA acquisition was similar or higher than reported prognostic factors for relapsed AML patients. These findings suggested that clonal evolution detected with conventional cytogenetic analysis at the first relapse induces severe chemo‐refractory characteristics in AML cells and should be considered as a potent prognostic factor when evaluating accurate prognosis in relapsed AML patients.