PROGNOSTIC IMPORTANCE OF RETINOPATHY IN ACUTE-LEUKEMIA

This prospective study evaluates the relationship, between the fundus findings in leukemic retinopathy and the survival in patients with new ly diagnosed acute leukemia. Fifty-four newly diagnosed consecutive pa tients with acute leukemia were included in this study. The patients w ere examined within few days of initial admission and diagnosis. Leuke mic retinopathy was detected in 19 (35%) patients. The observation per iod ranged from 434 days to 1220 days (mean +/- SD 880 +/- 225) for th ose patients who survived. Despite similar chemotherapy regimens, the mean and median survival times were shorter in patients with retinopat hy compared to those without retinopathy (332.4 +/- 99.6 and 76 vs. 64 0.7 +/- 106 and 192 days respectively) although survival did not diffe r significantly (p=0.073). Patients with cotton-wool spots had lower m ean and median survival times than did those without such lesions (168 .8 +/- 70.9 and 27 vs. 609.4 +/- 91.4 and. 289 days respectively) and survival differed significantly (p=0.04). The presence of cotton-wool spots and age greater than or equal to 40 years were the major adverse prognostic factors for survival in multivariate analysis. Cotton-wool spots had a more significant adverse prognostic effect than age great er than or equal to 40 years (hazard function coefficients: 1.0708 for cotton-wool spots vs. 0.0355 for age greater than or equal to 40 year s). The relative odds of dying among patients with cotton-wool spots w ere about 8 times higher than that for those without this feature, and about 7 times higher in patients aged greater than or equal to 40 yea rs than that for patients aged <20 years. Our findings suggest that th e presence of leukemic retinopathy in general, and cotton-wool spots, in particular is a poor prognostic sign for survival in acute leukemia .