Prognostic factors and outcome of core binding factor acute myeloid leukemia patients with t(8;21) differ from those of patients with inv(16):: A cancer and leukemia group B study
Prognostic factors and outcome of core binding factor acute myeloid leukemia patients with t(8;21) differ from those of patients with inv(16):: A cancer and leukemia group B study
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DOI：
10.1200/jco.2005.15.610
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发表时间：
2005-08-20
影响因子：
45.3
通讯作者：
Bloomfield, CD
中科院分区：
文献类型：
--
作者：
Marcucci, G;Mrózek, K;Bloomfield, CD
目的因为两个t（8; 21）和inv（16）破坏了急性髓性白血病（AML）中的核心结合因子（CBF），这些细胞遗传学组通常被治疗（AML），并类似地赋予相对有利的治疗。然而，最近的研究表明，这两个群体的基因谱不同，强调了潜在的生物学差异。因此，我们试图确定这两个细胞遗传学组是否也应该被认为是独立的实体从临床patients.Patients和方法，我们分析了144个连续的成人与t（8;21）和168与inv（16）治疗癌症和白血病组B一线研究。结果中位随访6.4年，CBF AML总体CR率为88%，5年OS为50%，CIR为53%。校正协变量后，t（8;21）患者的OS（风险比[HR] = 1.5; P = 0.045）和首次复发后生存率（HR = 1.7; P = 0.009）均短于inv（16）患者。出乎意料的是，种族是t（8;12）AML的一个重要预测因素，因为当存在某些继发性细胞遗传学异常时，非白人诱导失败的频率更高（比值比= 5.7; P = 0.006），OS比白人短。在t（8;21）小于60岁的患者中，诱导类型也与复发风险相关。对于inv（16）AML，继发性细胞遗传学异常（尤其是+22）和男性可预测更好的预后。结论当考虑种族、继发性细胞遗传学异常、性别和对挽救治疗的反应对预后的影响时，t（8;21）和inv（16）AML似乎是不同的临床实体，应分层并单独报告。
Purpose Because both t(8;21) and inv(16) disrupt core binding factor (CBF) in acute myeloid leukemia these cytogenetic groups are often treated (AML) and confer relatively favorable prognoses, similarly. Recent studies, however, have shown different gene profiling for the two groups, underscoring potential biologic differences. Therefore, we sought to determine whether these two cytogenetic groups should also be considered separate entities from a clinical standpoint.Patients and Methods We analyzed 144 consecutive adults with t(8;21) and 168 with inv(16) treated on Cancer and Leukemia Group B front-line studies. We compared pretreatment features, probability of achieving complete remission (CR), overall survival (CIS) and cumulative incidence of relapse (CIR) between the two groups.Results With a median follow-up of 6.4 years, for CBF AML as a whole, the CR rate was 88%, 5-year OS was 50% and CIR was 53%. After adjusting for covariates, patients with t(8;21) had shorter OS (hazard ratio [HR] = 1.5; P = .045) and survival after first relapse (HR = 1.7; P = .009) than patients with inv(16). Unexpectedly, race was an important predictor for t(8;12) AML, in that nonwhites failed induction more often (odds ratio = 5.7; P = .006) and had shorter OS than whites when certain secondary cytogenetic abnormalities were present. In patients with t(8;21) younger than 60 years, type of induction also correlated with relapse risk. For inv(16) AML, secondary cytogenetic abnormalities (especially +22) and male sex predicted better outcome.Conclusion When the prognostic impact of race, secondary cytogenetic abnormalities, sex, and response to salvage treatment is considered, t(8;21) and inv(16) AMLs seem to be distinct clinical entities and should be stratified and reported separately.