Karyotypic analysis predicts outcome of preremission and postremission therapy in adult acute myeloid leukemia: a Southwest Oncology Group/Eastern Cooperative Oncology Group study
Karyotypic analysis predicts outcome of preremission and postremission therapy in adult acute myeloid leukemia: a Southwest Oncology Group/Eastern Cooperative Oncology Group study
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DOI：
10.1182/blood.v96.13.4075
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发表时间：
2000-12-15
期刊：
影响因子：
20.3
通讯作者：
Appelbaum, FR
中科院分区：
文献类型：
--
作者：
Slovak, ML;Kopecky, KJ;Appelbaum, FR
在一项临床试验中，对 609 名年龄小于 56 岁的既往未经治疗的 AML 患者进行了细胞遗传学与完全缓解 (CR) 率、总生存率 (OS) 和 CR 后结局之间的关系的研究，该试验比较了 3 种强化缓解后治疗：强化化疗、自体移植 (ABMT) 或匹配相关供体的同种异体骨髓移植 (alloBMT)。根据治疗前核型将患者分为有利、中等、不利和未知细胞遗传学风险组。 4 组间 CR 率差异显着 (P < .0001)：有利，84%（95% 置信区间 [CI]，77%-90%）；中间，76%（CI，71%-81%）；不利，55%（CI，48%-63%）；未知，54%（CI，33%-74%）。 OS 也存在类似的显着异质性 (P < .0001)，与有利组相比，中等风险组、不利风险组和未知风险组的全因死亡估计相对风险分别为 1.50 (CI, 1.10-2.05)、3.33 (CI, 2.43-4.55) 和 2.66 (CI, 1.59-4.45)。在多变量分析中，细胞遗传学风险状态对 CR 率和 OS 的影响无法用其他患者或疾病特征来解释。在缓解后患者中，CR 生存率在有利组、中间组和不利组之间存在显着差异 (P = .0003)，有显着证据表明治疗效果和细胞遗传学风险状态对生存的影响之间存在相互作用 (P = .017)。细胞遗传学良好的患者在接受 ABMT 和 alloBMT 后的表现明显优于单独化疗，而细胞遗传学不利的患者在接受 alloBMT 后表现更好。细胞遗传学风险状态是预测 AML 患者对治疗反应的重要因素；然而，为了加强基因定义的 AML 亚型中治疗的相关性，需要一个更大的白血病细胞遗传学数据库。 (C) 2000 年，美国血液学会。
The associations of cytogenetics with complete remission (CR) rates, overall survival (OS), and outcomes after CR were studied in 609 previously untreated AML patients younger than 56 years old in a clinical trial comparing 3 intensive postremission therapies: intensive chemotherapy, autologous transplantation (ABMT), or allogeneic bone marrow transplantation (alloBMT) from matched related donors. Patients were categorized into favorable, intermediate, unfavorable, and unknown cytogenetic risk groups based on pretreatment karyotypes. CR rates varied significantly (P < .0001) among the 4 groups: favorable, 84% (95% confidence interval [CI], 77%-90%); intermediate, 76% (CI, 71%-81%); unfavorable, 55% (CI, 48%-63%); and unknown, 54% (CI, 33%-74%). There was similar significant heterogeneity of OS (P < .0001), with the estimated relative risk of death from any cause being 1.50 (CI, 1.10-2.05), 3.33 (CI, 2.43-4.55), and 2.66 (CI, 1.59-4.45) for the intermediate, unfavorable, and unknown risk groups, respectively, compared with the favorable group. In multivariate analyses, the effects of cytogenetic risk status on CR rate and OS could not be explained by other patient or disease characteristics. Among postremission patients, survival from CR varied significantly among favorable, intermediate, and unfavorable groups (P = .0003), with significant evidence of interaction (P = .017) between the effects of treatment and cytogenetic risk status on survival. Patients with favorable cytogenetics did significantly better following ABMT and alloBMT than with chemotherapy alone, whereas patients with unfavorable cytogenetics did better with alloBMT. Cytogenetic risk status is a significant factor in predicting response of AML patients to therapy; however, to tighten treatment correlates within genetically defined AML subsets, a significantly larger leukemia cytogenetic database is warranted. (C) 2000 by The American Society of Hematology.