KARYOTYPE IN ACUTE MYELOBLASTIC-LEUKEMIA - PROGNOSTIC-SIGNIFICANCE INA PROSPECTIVE-STUDY ASSESSING BONE-MARROW TRANSPLANTATION IN FIRST REMISSION

To evaluate the prognostic value of the karyotype in acute myeloblasti c leukemia when patients are allocated to have either autologous bone marrow transplantation (BMT) or allogeneic BMT at the time of first re mission (CR1), we have prospectively followed 134 consecutive patients from diagnosis. CR was achieved in 118 patients. Allogeneic BMT and a utologous BMT were performed in 25 and 43 CR1 patients, respectively. Applying the karyotype classification of Keating et al for remission d uration (favorable: t(15;17), inv(16); intermediate: normal, X -Y, t(8 ;21); unfavorable: other abnormalities), 10 patients had a favorable, 49 an intermediate, and 44 an unfavorable karyotype. The 5-year leukem ia-free survival (LFS) probabilities for patients with a good, interme diate and unfavorable karyotype were 65%, 32% and 11%, respectively (l og rank test P = 0.0019). The probabilities of relapse were 35% in pat ients with a favorable karyotype, 52% with an intermediate karyotype a nd 87% with an unfavorable karyotype (P = 0.0004). In the patients who had autologous BMT in CR1, the LFSs were 100%, 33% and 10% with favor able, intermediate and unfavorable karyotype, respectively (P = 0.04). The karyotype was of no prognostic value in patients receiving alloge neic BMT who had BMT in CR1. This study shows that the karyotype retai ns its prognostic value when the intention Is to treat patients with a cute myeloblastic leukemia in CR1 with BMT. Autologous BMT was not abl e to improve the poor prognosis associated with an unfavorable karyoty pe.