Blood Res.  2016 Sep;51(3):175-180. 10.5045/br.2016.51.3.175.

Evaluation of prognostic factors in patients with relapsed AML: Clonal evolution versus residual disease

• Kim H
• Seol YM
• Song MK
• Choi YJ
• Shin HJ
• Park SH
• Lee EY
• Chung JS

• KMID: 2353498
• DOI: http://doi.org/10.5045/br.2016.51.3.175

Abstract

BACKGROUND
It is widely known that the prognosis of acute myeloid leukemia (AML) depends on chromosomal abnormalities. The majority of AML patients relapse and experience a dismal disease course despite initial remission.
METHODS
We reviewed the medical records and laboratory findings of 55 AML patients who had relapsed between 2004 and 2013 and who had been treated at the Division of Hematology of the Pusan National University Hospital.
RESULTS
The event-free survival (EFS) was related to prognostic karyotype classification at the time of diagnosis and relapse (unfavorable vs. favorable or intermediate karyotypes at diagnosis, 8.2 vs. 11.9 mo, P=0.003; unfavorable vs. favorable or intermediate karyotypes at relapse, 8.2 vs. 11.9 mo, P=0.009). The overall survival (OS) was significantly correlated with karyotype classification only at diagnosis (unfavorable vs. favorable or intermediate vs. karyotypes at diagnosis, 8.5 vs. 21.8 mo, P=0.001; unfavorable vs. favorable or intermediate karyotypes at relapse, 8.5 vs. 21.2 mo, P=0.136). A change in karyotype between diagnosis and relapse, which is regarded as a factor of resistance against treatment, was not a significant prognostic factor for OS, EFS, and post-relapse survival (PRS). A Cox proportional hazards model showed that the combined use of fludarabine, cytosine arabinoside, and granulocyte colony-stimulating factor (FLAG) as a salvage regimen, was a significant prognostic factor for OS (hazard ratio=0.399, P=0.010) and the PRS (hazard ratio=0.447, P=0.031).
CONCLUSION
The karyotype classification at diagnosis predicts survival including PRS in relapsed AML patients as well as in treatment-naïve patients. We suggest that presently, administration of salvage FLAG could be a better treatment option.

Keyword

Relapsed AML; Karyotypic change; FLAG regimen

MeSH Terms

Busan
Chromosome Aberrations
Classification
Clonal Evolution*
Cytarabine
Diagnosis
Disease-Free Survival
Granulocyte Colony-Stimulating Factor
Hematology
Humans
Karyotype
Leukemia, Myeloid, Acute
Medical Records
Prognosis
Proportional Hazards Models
Recurrence
Cytarabine
Granulocyte Colony-Stimulating Factor

Figure

• 

  Fig. 1 (A) Overall survival (OS) of acute myeloid leukemia (AML) patients according to the cytogenetic group at diagnosis. (B) Event-free survival (EFS) in AML patients according to the cytogenetic group at relapse. (C) Post-relapse survival (PRS) in AML patients according to the cytogenetic group at diagnosis.

• 

  Fig. 2 Overall survival (OS) according to prognostic scoring for acute myeloid leukemia (AML) at first relapse. The scores for patients in the favorable risk group were 1–6 points, those for patients in the intermediate risk group were 7–9 points, and those for the patients in the poor risk group were 10–14 points.

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