Haematologica. 2014 Feb;99(2):308-13. doi: 10.3324/haematol.2013.092072. Epub 2013 Oct 4.
We investigated whether octogenarian patients with acute myeloid leukemia enrolled onto Cooperative Group clinical trials and treated with intensive induction therapy could be cured, and whether karyotype and selected molecular markers had any prognostic significance in these patients. Among 138 patients with cytogenetic information, normal karyotype was the most common (47.1%) followed by complex karyotype (14.5%) and sole +8 (9.4%). Among these patients, the relapse-free survival rate at 1 year was 37% and 13% at 3 years, and the respective overall survival rates were 24% and 8%. Whereas the 90 patients who survived beyond 30 days had the same relapse-free survival rates, their 1-year and 3-year overall survival rates were 36% and 11%, respectively. Of the 66 patients surviving beyond 30 days who could be classified into European LeukemiaNet genetic groups, those in the intermediate-I group had better overall survival than patients in the adverse group (P=0.01). Among patients with cytogenetically normal acute myeloid leukemia who were tested for the European LeukemiaNet-associated molecular alterations, FLT3-internal tandem duplication and NPM1 mutations, it was found that FLT3-internal tandem duplication (detected in 29% of patients) did not associate with overall survival (P=0.31), whereas NPM1 mutations (30%) were associated with a significantly longer overall survival (P=0.002). We conclude that intensive induction is effective and indicated in selected octogenarians with acute myeloid leukemia, that their overall survival varies among the European LeukemiaNet genetic groups and that NPM1 mutations may be of prognostic significance among octogenarian patients with cytogenetically normal acute myeloid leukemia.
我们研究了是否可以治愈入组合作组临床试验并接受强化诱导治疗的 80 岁以上急性髓系白血病患者，以及核型和选定的分子标志物在这些患者中是否具有预后意义。在具有细胞遗传学信息的 138 例患者中，正常核型最为常见（47.1%），其次是复杂核型（14.5%）和单独+8（9.4%）。在这些患者中，1 年无复发生存率为 37%，3 年为 13%，相应的总生存率为 24%和 8%。而在 30 天以上存活的 90 例患者中，无复发生存率相同，其 1 年和 3 年总生存率分别为 36%和 11%。在可以归入欧洲白血病网（European LeukemiaNet）遗传组的 66 例存活超过 30 天的患者中，中间 I 组的总体生存率优于不良组（P=0.01）。在接受欧洲白血病网相关分子改变检测的核型正常的急性髓系白血病患者中，发现 FLT3 内部串联重复和 NPM1 突变，FLT3 内部串联重复（在 29%的患者中检测到）与总体生存率无关（P=0.31），而 NPM1 突变（30%）与总体生存率显著延长相关（P=0.002）。我们的结论是，强化诱导在有选择的 80 岁以上急性髓系白血病患者中是有效的和有指征的，他们的总体生存率在欧洲白血病网遗传组中有所不同，而 NPM1 突变在核型正常的急性髓系白血病 80 岁以上患者中可能具有预后意义。
