PROGNOSTIC-SIGNIFICANCE OF DYSPLASTIC FEATURES OF HEMATOPOIESIS IN PATIENTS WITH DE-NOVO ACUTE MYELOGENOUS LEUKEMIA

The detection of dysplastic features of hematopoiesis in de novo acute myeloid leukemia (AML) by light microscopy is defined as AML with tri lineage myelodysplasia (AML/TLMD). The prognostic relevance of these d ysplastic features for patients with de novo AML remains unclear. In o rder to evaluate the role of dysplasia in de novo AML, bone marrow asp irates from 69 patients were analyzed prospectively and investigated s eparately for erythropoiesis, granulopoiesis and megakaryopoiesis by t hree independent investigators. The overall complete remission (CR) ra te was 48.8% and partial remission (PR) or nonresponders consituted 52 .2% of the patients investigated. The median overall survival time was 5 months with a disease-free interval of 3.5 months for all patients. Dysgranulopoiesis (DysG) was observed in 30.4%, dysmegakaryopoiesis ( DysM) in 50.7%, and dyserythropoiesis (DysE) in 43.5%. Of all patients , 26.0% showed trilineage dysplastic features and were thus classified as AML/TLMD. A significantly worse prognosis (Kaplan-Meyer plot, Stud ent's t-test) was calculated for those patients with detection of only DysG (p=0.002), DysM (p=0.02), DysE (p = 0.04) as compared with patie nts without any dysplastic signs. An unfavorable karyotype was correla ted with patients showing DysG (P=0.02) and DysM (P=0.04). For these p atients with an unfavorable karyotype, the occurrence of any dysplasti c features had no additional prognostic impact. Dysplastic features (D ysG, DysM, DysE) seem to be an important prognostic factor in de novo AML correlating with short overall survival. DysG and DysM correlated well with the appearance of unfavorable chromosomal abnormalities. It may be reasonable to assume that patients with dysplastic features sho uld be considered for more aggressive treatment schedules at the time of diagnosis.