Kantarjian H M, Keating M J, Walters R S, McCredie K B, Freireich E J
Department of Hematology, University of Texas M.D. Anderson Hospital and Tumor Institute, Houston 77030.
J Clin Oncol. 1988 Feb;6(2):232-8. doi: 10.1200/JCO.1988.6.2.232.
The characteristics and outcome of 58 patients with acute myelogenous leukemia (AML) who experienced relapse after a first remission duration longer than 18 months (late-relapse AML) were analyzed and compared with those of 278 patients with earlier relapses. Late-relapse AML was associated with a lower incidence of antecedent hematologic disorder, leukocytosis, and elevated creatinine and lactic acid dehydrogenase (LDH) levels. A favorable karyotype (inversion of chromosome 16; translocations between chromosomes 8 and 21, or 15 and 17) was more frequent in patients whose first remission was 12 months or longer compared with less than 12 months (30% v 10%; P less than .0001). An unfavorable karyotype (chromosome 5 and 7 abnormalities, trisomy 8, other changes) was more frequent in the latter category (16% v 42%; P less than .0001). Thirty-seven of the 58 patients (64%) with late-relapse AML achieved complete remission (CR). The incidence of CR increased significantly with an increased first remission duration from less than 12, 12 to 18, and greater than 18 months (17% v 41% v 64%; P less than .0001), while the incidence of resistant disease was significantly lower (59% v 36% v 19%; P less than .0001). When effective antileukemic regimens were considered, remission rates were also significantly increased by the duration of first remission (24% v 48% v 72%; P less than .001). Compared with patients with earlier relapse, those with late-relapse AML had a longer median survival from salvage therapy (3.5 v 12 months; P less than .01), and longer median second remission durations (3.5 v 11 months; P less than .01). We conclude that late-relapse AML has unique clinical, cytogenetic, and prognostic characteristics, and remains extremely sensitive to chemotherapy with a potential cure fraction. The duration of first remission is an important prognostic parameter in AML relapse and may be useful in the design and analysis of future salvage programs.
对58例首次缓解期超过18个月后复发的急性髓系白血病（AML）患者（晚期复发AML）的特征及转归进行分析，并与278例早期复发患者进行比较。晚期复发AML患者前驱血液系统疾病、白细胞增多症以及肌酐和乳酸脱氢酶（LDH）水平升高的发生率较低。首次缓解期为12个月或更长时间的患者，其核型良好（16号染色体倒位；8号与21号染色体、或15号与17号染色体易位）的情况比缓解期不足12个月的患者更常见（30%对10%；P＜0.0001）。核型不良（5号和7号染色体异常、8号染色体三体、其他改变）在后者中更常见（16%对42%；P＜0.0001）。58例晚期复发AML患者中有37例（64%）获得完全缓解（CR）。随着首次缓解期从不足12个月、12至18个月以及超过18个月延长，CR发生率显著增加（17%对41%对64%；P＜0.0001），而耐药疾病的发生率显著降低（59%对36%对19%；P＜0.0001）。当考虑有效的抗白血病方案时，首次缓解期的长短也使缓解率显著增加（24%对48%对72%；P＜0.001）。与早期复发患者相比，晚期复发AML患者挽救治疗后的中位生存期更长（3.5个月对12个月；P＜0.01），第二次缓解期的中位持续时间也更长（3.5个月对11个月；P＜0.01）。我们得出结论，晚期复发AML具有独特的临床、细胞遗传学和预后特征，并且对化疗仍极为敏感，有潜在的治愈比例。首次缓解期的长短是AML复发的一个重要预后参数，可能有助于未来挽救方案的设计和分析。
