Prognostic Parameters of Acute Myeloid Leukaemia at Presentation

Med Arch. 2017 Feb;71(1):20-24. doi: 10.5455/medarh.2017.71.20-24. Epub 2017 Feb 5.

Abstract

Introduction: The treatment response and outcome in acute myeloid leukaemia (AML) is heterogeneous.

Aim: To analyze the prognostic parameters of AML at presentation.

Methods: The total sample of 44 AML patients was analyzed on the basis of age <55 and ≥55 years, sex, WBC count <50x10/9/l and ≥50x10/9/l, the Hb concentration <100 g/l and ≥100 g/l, PLT count <100x10/9/l and ≥100x10/9/l, Karnofsky score <60% and >60%, cytogenetics, CD56 expression, morphological type and types of treatment (standard and reduced induction chemotherapy, high-dose chemotherapy/stem cell transplantation - autologous and HLA matched, related, allogeneic, together and separately).

Results: The age <55 years, Karnofsky score >60% and standard induction chemotherapy statistically correlated with the higher complete remission (CR) rates, longer relapse free survival (RFS), lower relapse rate (RR), and longer overall survival (OS) (p<0.01). The difference in terms of CR and RR between the sexes were not statistically significant (p<0.05), however women had statistically lower OS comparing to men (9.71±4.54 months vs. 38.03±9.17 months) (p<0.01). WBC count ≥ 50x10/9/l and the Hb concentration <100 g/l statistically correlated with shorter OS (p<0.05), while the WBC count ≥50x10/9/l statistically correlated with shorter RFS (p<0.05). The PLT count <100x10/9/l and ≥100x10/9/l was not found as prognostically significant for CR, RR, RFS, and OS (p<0.05). In comparison to the standard induction chemotherapy, both types of high dose chemotherapy/stem cell transplantation (HDT/SCT) (10/22), together and separately, resulted in longer RFS, lower RR, and longer OS (p<0.05). The frequency of cytogenetic risk was intermediate 81.6%, unfavorable 13.2%, and favorable 5.3%, respectively. CD56 + expression statistically correlated with the lower PLT count, higher RR, shorter RFS, and shorter OS (p<0.05). Statistical analysis of the cytogenetic risk and morphological types of AML were not possible due to the small number of patients in stratified groups.

Conclusions: Female sex, the WBC count >50x10/9/l, the concentration of Hb <100 g/l, and CD56 + expression, at presentation of AML, should be considered as parameters of adverse risk, especially in latter decisions considering post-remission treatment with HDT/SCT.

Keywords: acute myeloid leukaemia; prognosis; prognostic parameter.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use*
  • Bosnia and Herzegovina
  • CD56 Antigen
  • Cytogenetics*
  • Disease-Free Survival
  • Female
  • Gene Expression Regulation, Leukemic / genetics*
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Induction Chemotherapy*
  • Karnofsky Performance Status
  • Leukemia, Myeloid, Acute / diagnosis*
  • Leukemia, Myeloid, Acute / drug therapy
  • Leukemia, Myeloid, Acute / genetics
  • Leukemia, Myeloid, Acute / mortality
  • Male
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Remission Induction / methods
  • Retrospective Studies
  • Risk Factors
  • Sex Distribution
  • Young Adult

Substances

  • Antineoplastic Agents
  • CD56 Antigen
  • NCAM1 protein, human