Pretreatment cytogenetics add to other prognostic factors predicting complete remission and long-term outcome in patients 60 years of age or older with acute myeloid leukemia: results from Cancer and Leukemia Group B 8461
Author:
Farag Sherif S.1, Archer Kellie J.1, Mrózek Krzysztof1, Ruppert Amy S.1, Carroll Andrew J.1, Vardiman James W.1, Pettenati Mark J.1, Baer Maria R.1, Qumsiyeh Mazin B.1, Koduru Prasad R.1, Ning Yi1, Mayer Robert J.1, Stone Richard M.1, Larson Richard A.1, Bloomfield Clara D.1
Affiliation:
1. From The Ohio State University, Columbus, OH; Virginia Commonwealth University, Richmond, VA; The Cancer and Leukemia Group B (CALGB) Statistical Center, Durham, NC; University of Alabama at Birmingham, Birmingham, AL; University of Chicago, Chicago, IL; Wake Forest University, Winston-Salem, NC; Roswell Park Cancer Institute, Buffalo, NY; Duke University, Durham, NC; North Shore University, Manhasset, NY; University of Maryland, Baltimore, MD; and Dana Farber Cancer Institute, Boston, MA.
Abstract
We investigated the relative prognostic significance of cytogenetics in 635 adult acute myeloid leukemia (AML) patients 60 years of age or older treated on front-line protocols. Classification trees and tree-structured survival analysis (TSSA) were used to identify important cytogenetic groups, and their prognostic significance was then assessed in multivariable analysis (MVA). Overall, 48.5% achieved complete remission (CR); 6.6% survived at 5 years. Complex karyotypes with at least 3 abnormalities (complex ≥ 3) and a group including “rare aberrations” predicted lower CR rates (25% and 30%) versus other patients (56%). Compared with complex ≥ 3, the odds of CR were significantly higher for noncomplex karyotypes without rare aberrations on MVA. Cytogenetically, complex ≥ 5 predicted inferior disease-free survival on TSSA, remaining significant on MVA together with white blood cell count (WBC), sex, and age. For survival, complex ≥ 5, rare aberrations, and core-binding factor (CBF) abnormalities were prognostic (P < .001), with 5-year survivals of 0%, 0%, and 19.4%, respectively, and 7.5% for remaining patients. Together with WBC, marrow blasts, sex, and age, the cytogenetic groups remained significant on MVA. In conclusion, pretreatment cytogenetics adds to other prognostic factors in older AML patients. Patients with complex ≥ 5 appear to benefit minimally from current treatment and are better suited for investigational therapy or supportive care. (Blood. 2006;108:63-73)
Publisher
American Society of Hematology
Subject
Cell Biology,Hematology,Immunology,Biochemistry
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