Pretreatment cytogenetic abnormalities are predictive of induction success, cumulative incidence of relapse, and overall survival in adult patients with de novo acute myeloid leukemia:: results from Cancer and Leukemia Group B (CALGB 8461)
Pretreatment cytogenetic abnormalities are predictive of induction success, cumulative incidence of relapse, and overall survival in adult patients with de novo acute myeloid leukemia:: results from Cancer and Leukemia Group B (CALGB 8461)
复制标题
DOI：
10.1182/blood-2002-03-0772
复制
发表时间：
2002-12-15
期刊：
影响因子：
20.3
通讯作者：
Bloomfield, CD
中科院分区：
文献类型：
--
作者：
Byrd, JC;Mrózek, K;Bloomfield, CD
我们前瞻性地分析了 1213 名患有新发急性髓系白血病 (AML) 的成人，以确定细胞遗传学异常对完全缓解 (CR) 率、5 年累积复发率 (CIR) 和 5 年总生存率 (OS) 的预后影响。所有患者均接受类似的诱导治疗。存活患者的中位随访时间为 8.3 年。非优先细胞遗传学将 t(8;21) 和 inv(16)/t(16;16) 区分为比正常核型具有显着更好的预后。许多异常的预后影响无法独立确定，因为它们与复杂的核型有关。复杂核型和继发性畸变均不影响 t(8;21)、inv(16)/t(16;16) 或 t(9;11) 患者的结果。在其他患者中，具有复杂核型的患者的结果明显比细胞遗传学正常的患者差。根据特定细胞遗传学异常和核型复杂性的结果，患者被分为 3 个风险组：有利组（CR 88%、CIR 54%、OS 55%）、中间组（CR 67%、CIR 67%、OS 24%）和不利组（CR 32%、CIR 92%、OS 5%）。多变量分析证实了细胞遗传学对获得 CR、CIR 和 OS 概率的主要贡献。对于不良风险组，达到CR的概率比中间组和有利组分别低4.0和11.9倍，复发概率高3.0和4.4倍，死亡风险分别高2711和4.3倍。我们的结论是，尽管许多反复出现的异常的预后影响尚未独立于复杂的核型而确定，但细胞遗传学是预测成人 AML 达到 CR、CIR 和长期生存的最有用因素之一。
We analyzed prospectively 1213 adults with de novo acute myeloid leukemia (AML) to ascertain the prognostic impact of cytogenetic abnormalities on complete remission (CR) rate, 5-year cumulative incidence of relapse (CIR), and 5-year overall survival (OS). All patients received similar induction therapy. Median follow-up for surviving patients was 8.3 years. Nonprioritized cytogenetics distinguished t(8;21) and inv(16)/t(16;16) as conferring a significantly better prognosis than normal karyotype. Prognostic impact of many abnormalities could not be determined independently because of their association with complex karyotype. Neither complex karyotype nor secondary aberrations affected outcome of patients with t(8;21), inv(16)/t(16;16), or t(9;11). Among other patients, those with complex karyotypes had significantly worse outcomes than cytogenetically normal patients. Based on outcome for specific cytogenetic abnormalities and karyotype complexity, patients were divided into 3 risk groups: favorable (CR 88%, CIR 54%, OS 55%), intermediate (CR 67%, CIR 67%, OS 24%), and adverse (CR 32%, CIR 92%, OS 5%). Multivariate analyses confirmed the major contribution of cytogenetics to the probability of attaining CR, CIR, and OS. For the adverse-risk group, the probability of achieving CR was 4.0 and 11.9 times lower, the probability of relapse 3.0 and 4.4 times higher, and the risk of death 2711 and 4.3 times higher than those for the intermediate and favorable groups, respectively. We conclude that although the prognostic impact of many recurring abnormalities has not been ascertained independently of complex karyotype, cytogenetics is among the most useful factors predicting attainment of CR, CIR, and long-term survival in adult AML.