Delaunay Jacques, Vey Norbert, Leblanc Thierry, Fenaux Pierre, Rigal-Huguet Françoise, Witz Francis, Lamy Thierry, Auvrignon Anne, Blaise Didier, Pigneux Arnaud, Mugneret Francine, Bastard Christian, Dastugue Nicole, Van den Akker Jacqueline, Fière Denis, Reiffers Josy, Castaigne Sylvie, Leverger Guy, Harousseau Jean-Luc, Dombret Herve
Departement of Hematology, Hôpital Saint-Louis, Paris, France.
Blood. 2003 Jul 15;102(2):462-9. doi: 10.1182/blood-2002-11-3527. Epub 2003 Mar 20.
Acute myeloid leukemias (AMLs) carrying inv(16)/t(16;16) chromosomal abnormalities are associated with a good prognosis. However, studies of this AML subtype have been hampered by the few number of patients reported, frequently collectively considered with those with AML carrying the t(8;21) translocation. We performed a retrospective study in 110 patients with inv(16)/t(16;16) AML (median age, 34 years) prospectively enrolled in 6 trials conducted in France between 1987 and 1998, with the aim to investigate prognostic factors for complete remission (CR) achievement and outcome of CR patients in this AML subtype. CR rate was 93%. Bad-prognosis factors for CR achievement were higher white blood cell count (WBC) and lower platelet count (optimal cutpoints at 120 and 30 x 109/L, respectively). At 3 years, estimated overall survival, disease-free survival (DFS), and cumulative incidence of relapse were 58%, 48%, and 42%, respectively. In multivariate analysis, (1) advanced age (optimal cutpoint, 35 years) was the only factor for shorter DFS and (2) advanced age and low platelet count were the 2 factors for shorter survival of CR patients. Outcome of CR patients (1) was not influenced by WBC and cytogenetic findings and (2) was similar among patients allocated to receive allogeneic transplantation, high-dose, or intermediate-dose cytarabine. Interestingly, advanced age was associated with a trend for more frequent additional chromosome abnormalities and predictive of higher cumulative incidence of relapse rather than death in first CR. These results markedly contrast with those reported in patients with t(8;21) AML in whom WBC, and not age, was the main high-risk factor for relapse, DFS, and survival.
携带inv(16)/t(16;16)染色体异常的急性髓系白血病（AML）患者预后良好。然而，由于报道的患者数量较少，且常与携带t(8;21)易位的AML患者合并考虑，对这种AML亚型的研究受到了阻碍。我们对110例inv(16)/t(16;16) AML患者（中位年龄34岁）进行了一项回顾性研究，这些患者前瞻性纳入了1987年至1998年在法国进行的6项试验，目的是研究该AML亚型患者实现完全缓解（CR）的预后因素以及CR患者的结局。CR率为93%。实现CR的不良预后因素是白细胞计数（WBC）较高和血小板计数较低（最佳切点分别为120和30×10⁹/L）。3年时，估计总生存率、无病生存率（DFS）和复发累积发生率分别为58%、48%和42%。在多变量分析中，（1）高龄（最佳切点35岁）是DFS较短的唯一因素，（2）高龄和低血小板计数是CR患者生存时间较短的两个因素。CR患者的结局（1）不受WBC和细胞遗传学结果的影响，（2）在接受异基因移植、大剂量或中剂量阿糖胞苷治疗的患者中相似。有趣的是，高龄与更多额外染色体异常的趋势相关，并且预测首次CR时复发累积发生率较高而非死亡。这些结果与t(8;21) AML患者的报道结果明显不同，在t(8;21) AML患者中，WBC而非年龄是复发、DFS和生存的主要高危因素。
