ACUTE-LEUKEMIA TREATED WITH INTENSIVE CHEMOTHERAPY IN PATIENTS WITH AHISTORY OF PREVIOUS CHEMOTHERAPY AND OR RADIOTHERAPY - PROGNOSTIC-SIGNIFICANCE OF KARYOTYPE AND PRECEDING MYELODYSPLASTIC SYNDROME/

The prognostic significance of karyotype and of a preceding myelodyspl astic syndrome (MDS) was evaluated in 57 patients with acute leukemia (AL) treated with intensive chemotherapy. All patients had a history o f previous chemo- and/or radiotherapy for a neoplastic disease. Acute nonlymphocytic leukemia (ANLL) was diagnosed in 49 patients, six patie nts suffered from acute lymphatic leukemia (ALL) and one patient from biphenotypic and undifferentiated AL, respectively. Chromosomal aberra tion rate was 91%. In 54% of the patients, simple or specific chromoso mal anomalies with not more than three cytogenetic defects were found, such as t(8;21), t(15;17), inv(16), t(9;11) and t(4;11). Only 37% of the patients had a karyotype highly characteristic of sAL with more th an 4 structural cytogenetic defects, and/or -5, 5q-, -7, 7q-. This unu sual distribution of cytogenetic defects in these patients is undoubte dly due to patient selection, since only patients who received aggress ive chemotherapy were included in this study. 25 patients had previous ly been diagnosed as having MDS. Presence or absence of a preceding MD S and karyotype were predictive parameters for achievement of complete remission (CR). CR was obtained in 47% of the patients with normal ka ryotype or simple aberrations, but only in 24% of the patients with co mplex anomalies (p = 0.09). Patients without a prior MDS had a higher CR rate (53%) than patients with a preceding MDS (20%) (p = 0.02). CR rate was highest in patients with a normal karyotype or simple aberrat ions without previous MDS (56%), compared to those with complex anomal ies and a prior MDS (14%) (p = 0.02). We conclude that, from a clinica l point of view, AL in the former patients should be considered as de novo AL and not as secondary, therapy-related AL and that therapeutic nihilism is no longer justified in these patients.