High-resolution chromosomes as an independent prognostic indicator in adult acute nonlymphocytic leukemia.
High-resolution chromosomes as an independent prognostic indicator in adult acute nonlymphocytic leukemia.
复制标题
高分辨率染色体作为成人急性非淋巴细胞白血病的独立预后指标。
DOI：
10.1056/nejm198409273111302
复制
发表时间：
1984
期刊：
影响因子：
--
通讯作者：
Lobell,M
中科院分区：
文献类型：
--
作者：
Yunis,JJ;Brunning,RD;Howe,RB;Lobell,M
利用105例成人新发急性非淋巴细胞白血病患者骨髓标本的高分辨率染色体，我们发现这种疾病具有异常高的复杂性，这可能解释了以前在确定有用的预后指标方面的困难。来自105名患者中的99名患者的样本分析成功，其中92名(93%)有染色体缺陷。确定了17个类别，其中12个类别代表了一种特定的复发性缺陷。其中三个已被发现具有独立的预后重要性。根据法美英急性白血病合作研究组的形态学分类，倒置16例(9%)被诊断为M2、M4或M5b病，患者的完全缓解一致且持续，中位生存期为25个月。相比之下，14名(14%)患有复杂染色体异常并被诊断为M1、M2、M4、M5A或M6疾病的患者预后非常差。在14名患者中，有12名患者诱导缓解的努力失败，该组患者的中位生存期为2.5个月。第三组以8三体为单一缺陷(11%)，预后中等，中位生存期为10个月。鉴于目前治疗急性非淋巴细胞白血病的不同类型，我们认为高分辨率染色体分析将成为为不同预后的患者选择特定治疗类型的重要工具。(n Engl J Med 1984；311：812-8)
Using high-resolution chromosomes of bone-marrow specimens from 105 consecutive adult patients with de novo acute nonlymphocytic leukemia, we found an unusually high degree of complexity in this disorder, which may explain previous difficulties in identifying useful prognostic indicators. Specimens from 99 of the 105 patients were successfully analyzed, and 92 (93 per cent) had a chromosomal defect. Seventeen categories were identified, 12 representing a specific recurrent defect. Three of them have been found to have independent prognostic importance. Patients with an inversion 16 (9 per cent), diagnosed as having M2, M4, or M5b disease according to the morphologic classification of the French–American–British Acute Leukemia Cooperative Study Group, had a uniform and sustained complete remission and a median survival of 25 months. In contrast, 14 patients (14 percent) with complex chromosomal abnormalities and a diagnosis of M1, M2, M4, M5a, or M6 disease had a very poor prognosis. In 12 of the 14 patients efforts to achieve induction of remission failed, and the group had a median survival of 2.5 months. A third group with a trisomy 8 as the single defect (11 per cent) had an intermediate prognosis and a median survival of 10 months. With the different types of treatment for acute nonlymphocytic leukemia that are now available, we suggest that high-resolution chromosome analysis will become an important tool in selecting specific types of therapy for groups of patients with differing prognoses. (N Engl J Med 1984; 311:812–8.)