Additional chromosomal abnormalities in patients with acute promyelocytic leukaemia (APL) do not confer poor prognosis: results of APL 93 trial
Additional chromosomal abnormalities in patients with acute promyelocytic leukaemia (APL) do not confer poor prognosis: results of APL 93 trial
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DOI：
10.1046/j.1365-2141.2000.02442.x
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发表时间：
2000-12-01
影响因子：
6.5
通讯作者：
Fenaux, P
中科院分区：
文献类型：
--
作者：
de Botton, S;Chevret, S;Fenaux, P
尽管最近通过全反式维A酸（ATRA）和化疗（CT）相结合的治疗，急性早幼粒细胞白血病（APL）的结局有所改善，但一些患有该疾病的患者的结局仍然不佳。 APL 中除 t(15;17) 之外的染色体异常的预后意义尚不确定。我们检查了欧洲试验中 292 名接受 ATRA 和 CT 治疗的患者二次染色体变化的预后意义。除 t(15;17) 外，染色体异常的发生率为 26%，8 三体是最常见的继发性改变（继发性改变病例中 46%）。在有或没有额外重排的患者之间，在年龄、性别、初始白细胞计数、循环原始细胞百分比、血小板计数、纤维蛋白原水平和微粒变异发生率方面没有发现显着差异。仅患有 t(15;17) 的患者与患有 t(15;17) 和其他克隆异常的患者的完全缓解（分别为 92% 和 93%）、2 年无事件生存率（分别为 76.1% 和 78.1%）、2 年复发（分别为 16.7% 和 11.6%）以及 2 年总生存率（分别为 79.9% 和 11.6%）的结果也相似。分别为 79.5%）。根据诱导治疗类型（ATRA 随后 CT 或 ATRA 加 CT）或维持治疗类型（ATRA、低剂量 CT 或两者）进行的分析也未能显示两组之间有任何差异。因此，在接受 ATRA 和 CT 治疗的一大群 APL 患者中，额外的染色体异常对预后没有影响。
In spite of the recent improvement in the outcome of acute promyelocytic leukaemia (APL) with treatment combining all trans retinoic acid (ATRA) and chemotherapy (CT), some patients with this disease still have a poor outcome. The prognostic significance of chromosomal abnormalities in addition to t(15;17) in APL is uncertain. We examined the prognostic significance of secondary chromosomal changes in 292 patients included in a European trial who were treated with ATRA and CT. The incidence of chromosomal abnormalities in addition to t(15;17) was 26% and trisomy 8 was the most frequent secondary change (46% of the cases with secondary changes). No significant differences were seen with regard to age, sex, initial white blood cell count, % of circulating blasts, platelet count, fibrinogen level and incidence of microgranular variants between patients with or without additional rearrangements. Outcome was also similar between patients with t(15;17) alone and patients with t(15;17) and other clonal abnormalities for complete remission (92% vs. 93% respectively), event-free survival at 2 years (76.1% vs. 78.1% respectively), relapse at 2 years (16.7% vs. 11.6% respectively) and overall survival at 2 years (79.9% vs. 79.5% respectively). Analysis according to the type of induction treatment (ATRA followed by CT or ATRA plus CT) or the type of maintenance treatment (with ATRA, low-dose CT or both) also failed to show any difference between the two groups. Thus, in a large cohort of APL patients treated with ATRA and CT, additional chromosomal abnormalities had no impact on prognosis.