Bloomfield C D, Shuma C, Regal L, Philip P P, Hossfeld D K, Hagemeijer A M, Garson O M, Peterson B A, Sakurai M, Alimena G, Berger R, Rowley J D, Ruutu T, Mitelman F, Dewald G W, Swansbury J
Roswell Park Cancer Institute, Buffalo, New York, USA.
Cancer. 1997 Dec 1;80(11 Suppl):2191-8.
In 1982, the Fourth International Workshop on Chromosomes in Leukemia reviewed data prospectively collected on 716 patients with acute myeloid leukemia (AML) diagnosed between 1980 and 1982. The present study examined the extended follow-up on these patients.
The analyses included cytogenetic and clinical data, with a median follow-up of 14.7 years, from 54 patients with treatment-associated AML and 628 with de novo AML. Of these patients, 291 received induction therapy that would be considered standard by today's criteria; no patient received high-dose cytarabine (HiDAC) intensification.
Among the patients with treatment-associated AML, the only long-term survivor in retrospect appears to have had de novo AML. Among the patients with de novo AML, achievement of complete remission and survival varied significantly based on cytogenetic classification among all 628 patients as well as among those who did and did not receive standard induction therapy. The remission rate and survival were significantly better with standard induction therapy for patients with t(15;17) and normal cytogenetics. Multivariate analyses showed that karyotype was an independent predictor of survival for all patients and those receiving standard induction therapy. Only 8.9% of patients were alive 5 years following diagnosis, but 5 years of continuous remission was synonymous with cure. Even among 5-year survivors who had suffered a previous relapse, 41% appeared to be cured. Survival among patients in continuous remission for > or = 10 years varied significantly by cytogenetic classification. In the absence of HiDAC intensification, no complete responders with t(8;21) and only 7% with normal cytogenetics survived continuously 10 years disease free.
Cure of AML following specific therapies must be evaluated in the context of cytogenetics. A meta-analysis incorporating cytogenetic data is indicated for patients with > or = 10 years of follow-up.
1982年，第四届白血病染色体国际研讨会回顾了1980年至1982年间前瞻性收集的716例急性髓系白血病（AML）患者的数据。本研究对这些患者进行了延长随访。
分析纳入了54例治疗相关AML患者和628例初发AML患者的细胞遗传学和临床数据，中位随访时间为14.7年。这些患者中，291例接受了按当今标准可视为标准的诱导治疗；无一例患者接受大剂量阿糖胞苷（HiDAC）强化治疗。
在治疗相关AML患者中，回顾性来看唯一的长期存活者似乎患有初发AML。在初发AML患者中，所有628例患者以及接受和未接受标准诱导治疗的患者中，完全缓解的实现和生存情况根据细胞遗传学分类有显著差异。对于t(15;17)和细胞遗传学正常的患者，标准诱导治疗的缓解率和生存率显著更高。多因素分析表明，核型是所有患者以及接受标准诱导治疗患者生存的独立预测因素。仅8.9%的患者在诊断后5年存活，但5年持续缓解等同于治愈。即使在先前复发过的5年存活者中，41%似乎也已治愈。持续缓解≥10年的患者的生存情况根据细胞遗传学分类有显著差异。在没有HiDAC强化治疗的情况下，t(8;21)的完全缓解者无一例连续10年无病存活，细胞遗传学正常的完全缓解者只有7%连续10年无病存活。
必须在细胞遗传学背景下评估特定疗法后AML的治愈情况。对于随访≥10年的患者，应进行纳入细胞遗传学数据的荟萃分析。
