Morphologic dysplasia in de novo acute myeloid leukemia (AML) is related to unfavorable cytogenetics but has no independent prognostic relevance under the conditions of intensive induction therapy:: Results of a multiparameter analysis from the German AML cooperative group studies
Morphologic dysplasia in de novo acute myeloid leukemia (AML) is related to unfavorable cytogenetics but has no independent prognostic relevance under the conditions of intensive induction therapy:: Results of a multiparameter analysis from the German AML cooperative group studies
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DOI：
10.1200/jco.2003.08.005
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发表时间：
2003-01-15
影响因子：
45.3
通讯作者：
Hiddemann, W
中科院分区：
文献类型：
--
作者：
Haferlach, T;Schoch, C;Hiddemann, W
目的：根据法国-美国-英国（FAB）分类的细胞形态学，我们评估了新生急性髓系白血病（AML）中发育异常特征和其他参数的预后影响。我们还评估了最近推出的世界卫生组织 (WHO) AML 分类的临床意义，该分类提出将不典型增生作为分类的新参数。 患者和方法：我们前瞻性分析了 614 名新发 AML 患者，所有这些患者均通过中心形态学分析诊断并在德国 AML 合作组 (AMLCG)-92 或 AM-LCG 急性早幼粒细胞白血病研究中接受治疗。 结果： AML M3、与所有其他 FAB 亚型相比，M3v 或 M4eo 表现出更好的结果 (P < .001)；其他 FAB 亚型之间没有观察到预后差异。发育不良的存在或不存在未能证明预后相关性。其他预后标志物，如年龄、细胞遗传学、Auer 杆的存在和诊断时的乳酸脱氢酶 (LDH) 水平，在单变量分析中均显示出对总体生存率和无事件生存率的显着影响（所有测试参数的 P < .001）。然而，在多变量分析中，只有细胞遗传学（不利或有利）、年龄和高 LDH 维持其预后影响。未发现不典型增生是独立的预后参数，但三系不典型增生的检测与不利的细胞遗传学相关。结论：我们的结果表明，细胞形态学和根据 FAB 标准的分类对于 AML 的诊断仍然是必要的，但除细胞遗传学外，与预后无关。我们的结果表明，世界卫生组织的分类应该通过使用细胞遗传学作为生物学的主要决定因素来进一步发展。特别是，当考虑细胞遗传学时，发育不良特征对预测预后没有额外影响。 (C) 2003 年，美国临床肿瘤学会。
Purpose: On the basis of cytomorphology according to the French-American-British (FAB) classification, we evaluated the prognostic impact of dysplastic features and other parameters in de novo acute myeloid leukemia (AML). We also assessed the clinical significance of the recently introduced World Health Organization (WHO) classification for AML, which proposed dysplasia as a new parameter for classification.Patients and Methods: We analyzed prospectively 614 patients with de novo AML, all of whom were diagnosed by central morphologic analysis and treated within the German AML Cooperative Group (AMLCG)-92 or the AM-LCG-acute promyalocytic leukemia study.Results: Patients with AML M3, M3v, or M4eo demonstrated a better outcome compared with all other FAB sub-types (P < .001); no prognostic difference was observed among other FAB subtypes. The presence or absence of dysplasia failed to demonstrate prognostic relevance. Other prognostic markers, such as age, cytogenetics, presence of Auer rods, and lactate dehydrogenase (LDH) level at diagnosis, all showed significant impact on overall and event-free survival in univariate analyses (P < .001 for all parameters tested). However, in a multivariate analysis, only cytogenetics (unfavorable or favorable), age, and high LDH maintained their prognostic impact. Dysplasia was not found to be an independent prognostic parameter, but the detection of trilineage dysplasia correlated with unfavorable cytogenetics.Conclusion: Our results indicate that cytomorphology and classification according to FAB criteria are still necessary for the diagnosis of AML but have no relevance for prognosis in addition to cytogenetics. Our results suggest that the WHO classification should be further developed by using cytogenetics as the main determinant of biology. Dysplastic features, in particular, have no additional impact on predicting prognosis when cytogenetics are taken into account. (C) 2003 by American Society of Clinical Oncology.