Survival time in a population-based consecutive series of adult acute myeloid leukemia - the prognostic impact of karyotype during the time period 1976-1993

A consecutive population-based series of 372 adult acute myeloid leukemias, successfully cytogenetically investigated at a single center between 1976 and 1993, is reported. All medical records were reviewed in order to ascert ain the prognostic impact of karyotype, divided into three groups; favorabl e (t(8;21), t(15;17), and inv(16) irrespective of karyotypic complexity; n = 40), poor (der(1;7), inv(3), -5, del(5q), -7, t(9;22), and complex karyot ypes including whole or partial losses of chromosomes 5 and/or 7; n = 56), and intermediate (other abnormalities or normal karyotype; n = 276). The po ssible modification by age, gender, time period, morphologic subtype, and b one marrow transplantation (BMT) on this prognostic impact was also determi ned. The chemotherapy regimens used were heterogeneous over time but princi pally the same at any given point in time. The majority of the patients wer e treated with combinations including an anthracycline and cytarabine with curative intent. Gender, morphology, and BMT did not significantly modify t he effect of cytogenetic patterns on survival time, whereas age and time pe riod did. The hazard ratios for the subgroups favorable, intermediate, and poor were 1.0, 1.2 and 1.9 at age 20-49; 1.0, 2.5 and 4.5 at age 50-64; 7.0 , 4.1 and 11.4 at age 65-74; 1.0, 1.4 and 2.2 for the time period 1976-1987 and 1.0, 2.0 and 6.7 for 1988-1993. The salient feature of the Kaplan-Meie r curves was the improved survival during the later time period for patient s with favorable and intermediate cytogenetic abnormalities. The present fi ndings thus suggest that it is mainly these patient groups that have benefi ted from advances in therapy, including supportive care.