Leukemia. 1994 Jan;8(1):87-91.
The prognostic significance of karyotype and of a preceding myelodysplastic syndrome (MDS) was evaluated in 57 patients with acute leukemia (AL) treated with intensive chemotherapy. All patients had a history of previous chemo- and/or radiotherapy for a neoplastic disease. Acute nonlymphocytic leukemia (ANLL) was diagnosed in 49 patients, six patients suffered from acute lymphatic leukemia (ALL) and one patient from biphenotypic and undifferentiated AL, respectively. Chromosomal aberration rate was 91%. In 54% of the patients, simple or specific chromosomal anomalies with not more than three cytogenetic defects were found, such as t(8;21), t(15;17), inv(16), t(9;11) and t(4;11). Only 37% of the patients had a karyotype highly characteristic of sAL with more than 4 structural cytogenetic defects, and/or -5, 5q-, -7, 7q-. This unusual distribution of cytogenetic defects in these patients is undoubtedly due to patient selection, since only patients who received aggressive chemotherapy were included in this study. 25 patients had previously been diagnosed as having MDS. Presence or absence of a preceding MDS and karyotype were predictive parameters for achievement of complete remission (CR). CR was obtained in 47% of the patients with normal karyotype or simple aberrations, but only in 24% of the patients with complex anomalies (p = 0.09). Patients without a prior MDS had a higher CR rate (53%) than patients with a preceding MDS (20%) (p = 0.02). CR rate was highest in patients with a normal karyotype or simple aberrations without previous MDS (56%), compared to those with complex anomalies and a prior MDS (14%) (p = 0.02). We conclude that, from a clinical point of view, AL in the former patients should be considered as de novo AL and not as secondary, therapy-related AL and that therapeutic nihilism is no longer justified in these patients.
对57例接受强化化疗的急性白血病（AL）患者，评估了核型及既往骨髓增生异常综合征（MDS）的预后意义。所有患者既往均因肿瘤性疾病接受过化疗和/或放疗。49例患者诊断为急性非淋巴细胞白血病（ANLL），6例患者患急性淋巴细胞白血病（ALL），1例患者分别患双表型和未分化AL。染色体畸变率为91%。54%的患者发现有不超过3个细胞遗传学缺陷的简单或特定染色体异常，如t(8;21)、t(15;17)、inv(16)、t(9;11)和t(4;11)。只有37%的患者具有超过4个结构细胞遗传学缺陷和/或-5、5q-、-7、7q-的sAL高度特征性核型。这些患者中细胞遗传学缺陷的这种异常分布无疑是由于患者选择所致，因为本研究仅纳入了接受积极化疗的患者。25例患者既往被诊断为患有MDS。既往MDS的有无及核型是实现完全缓解（CR）的预测参数。核型正常或有简单畸变的患者中47%获得CR，但复杂异常患者中仅24%获得CR（p = 0.09）。无既往MDS的患者CR率（53%）高于有既往MDS的患者（20%）（p = 0.02）。与有复杂异常和既往MDS的患者（14%）相比，核型正常或有简单畸变且无既往MDS的患者CR率最高（56%）（p = 0.02）。我们得出结论，从临床角度看，前一组患者的AL应被视为原发性AL，而非继发性、治疗相关AL，并且对这些患者不再有理由采取治疗虚无主义。
