CHRONIC MYELOGENOUS LEUKEMIA IN BLAST CRISIS - RETROSPECTIVE ANALYSISOF PROGNOSTIC FACTORS IN 90 PATIENTS

Ninety patients with Philadelphia chromosome-positive chronic myelogen ous leukemia in blast crisis were reviewed to identify significant pro gnostic associations. At diagnosis of blast crisis the main clinical, laboratory, and cytogenetic data were recorded and evaluated for progn ostic significance. At the time of the analysis 89 patients had died, with a median survival of 11 weeks from diagnosis of blast crisis. Pat ient characteristics demonstrated in the univariate analysis to have s ignificant association with shorter survival were: thrombocythemia, le ukocyte count above 20 X 10(9), Karnofsky index < 50%, nonlymphoid bla st cell morphology, cytogenetic clonal evolution, the presence of a do uble Philadelphia chromosome or trisomy 8, and no response to therapy. In 17 of 59 patients (29%) evaluable for response to therapy a comple te or partial remission was achieved. These responders had a significa ntly longer median survival (25 weeks) as compared with nonresponders (9 weeks). Response to therapy was significantly better in lymphoid bl ast crisis and in patients without clonal evolution. In a multivariate analysis containing all significant variables of the univariate analy sis two parameters retained their prognostic significance: response to therapy and trisomy 8. In spite of the short overall survival in blas t crisis, the determination of prognostic factors may be a useful tool for the clinician planning therapy, especially new therapeutic approa ches.