PROGNOSTIC FACTORS IN CHRONIC MYELOID-LEUKEMIA - IMPORTANCE OF STAGING OR DISEASE BIOLOGY

The presenting clinical, haematological and cytogenetic features of 21 5 patients with a haematological diagnosis of chronic myeloid leukaemi a (CML) were analysed with a view to defining prognostic factors. Of t he 215 patients, 166 (77%) were found to be Philadelphia chromosome (P h')-positive. The frequency of Ph' and complex Ph' abnormalities was s imilar for black and white patients. Black patients, however, had a si gnificantly higher frequency of additional clonal chromosome abnormali ties at presentation compared with whites (15/87 v. 1/79). Blacks also tended to present with more advanced disease, lower haemoglobin value s, higher white cell counts, larger spleens and a higher frequency of lymphadenopathy and leukostasis. Median duration of survival from diag nosis of Ph'-positive patients was 44 months for whites and 30 months for blacks. The poorer survival of the black patients was in part acco unted for by the poor survival of patients with additional clonal chro mosomal abnormalities over and above Ph'. Black patients with only sim ple Ph' or complex Ph' had a similar survival to whites. In a multivar iate analysis, the significant factors determining survival were: (i) the presence of additional clonal chromosomal abnormalities; and (ii) peripheral blast count over 5%, platelet count outside the normal rang e and haemoglobin value less than 10 g/dl. These factors defined subgr oups of patients with median survival ranging from 12 months to 62 mon ths. The inclusion of patients with variable prognoses needs to be tak en into account when evaluating the results of new treatment modalitie s for CML.