THE PROGNOSTIC-SIGNIFICANCE OF CHROMOSOMAL ANALYSIS AND IMMUNOPHENOTYPING IN 117 PATIENTS WITH DE-NOVO ACUTE MYELOID-LEUKEMIA

Chromosomal abnormalities is one of the most important prognostic fact ors in acute myeloid leukemia (AML). Other parameters which may influe nce the prognosis include age, French-American-British-type, clinical variables and possibly the expression of certain immunophenotypic surf ace makers, However, only rarely has the expression of these markers b een analyzed in multivariate models including the information from cyt ogenetics and clinical variables. We conducted a retrospective study o f 117 consecutive adult patients with de novo AML diagnosed and treate d in our institution during a 6-year period, Following standard induct ion chemotherapy with daunomycin and cytosine arabinoside 75 patients (64%) achieved complete remission (CR). The overall 5 year survival ra te was 23% and, for patients achieving CR, 30%. When all patients were analyzed age, chromosomal aberration and lack of CD33 expression were of independent prognostic value. The overall 5 year survival rate was 28% for patients aged 55 years or younger, 25% for patients aged 56-6 5 years and 4% for those >65 years, P=0.041. Patients with good-risk c hromosomal abnormalities presented an overall 5 year survival of 36%, compared to 25% in patients with normal karyotype, 22% in patients wit h intermediate risk abnormalities and 5% in patients with poor-risk ab normalities, P=0.004. Patients with CD33(+) myeloblasts had an overall survival of 25% at 5 years compared to 0% in the CD33(-) patients, P= 0.021, Analysis of the expression of CD7, CD34 and terminal deoxynucle otidyl transferase on myeloblasts had no impact on overall survival in a multivariate analysis. Thus, this study confirmed the prognostic va lue of age and cytogenetic risk group and defined CD33 as a novel fact or of independent prognostic importance in adult de novo AML, (C) 1997 Elsevier Science Ltd.