Meckenstock G, Aul C, Hildebrandt B, Heyll A, Germing U, Wehmeier A, Giagounidis A, Suedhoff T, Burk M, Soehngen D, Schneider W
Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University of Duesseldorf, Germany.
Leuk Lymphoma. 1998 May;29(5-6):523-31. doi: 10.3109/10428199809050912.
Dyshematopoiesis was found in 44 (42.3%) of 104 cases of de novo acute myeloid leukemia (AML). Dyshematopoietic AML (dys-AML) and AML without hematopoietic dysplasia (non-dys-AML) were compared with regard to biological, hematological, immunophenotypic, and cytogenetic parameters as well as prognostic criteria. Median age of patients was 55 years in both groups. In dys-AML, the median leukocyte count (p = 0.04), peripheral blast (p = 0.02) and medullary blast cell count (p < 0.001) were significantly decreased, whereas the median platelet count (p - 0.04) was increased. Immunophenotyping demonstrated that leukemic blast cells in dys-AML more frequently expressed the adhesion molcules CD54 (p = 0.05) and CD58 (p = 0.08) than leukemic cells in non-dys-AML. Cytogenetically, we distinguished two karyotypic patterns, one group with a normal karyotype or prognostically favorable single chromosome aberrations ("P(0)-karyotype"), and another one with unfavorable single aberrations or complex aberrations ("P(1)-karyotype"). The incidence of these groups was not significantly different between dys-AML and non-dys-AML. Complete remission rate (CRR) after induction chemotherapy (p = 0.03) and overall survival time (OS; p = 0.03) were significantly lower in dys-AML. In addition, median disease free survival (DFS; p = n.s.) was inferior compared to non-dys-AML. In the dys-AML as well as in the non-dys-AML patient group, CRR, DFS, and OS were decreased in the P(1)-compared to the P(0)-subgroup. We conclude that dyshematopoietic AML is characterized by specific cell biological features and that hematopoietic and cytogenetic status represent complementary prognostic factors in de novo AML.
在104例初发急性髓系白血病（AML）患者中，44例（42.3%）存在造血异常。对造血异常AML（dys-AML）和无造血发育异常的AML（非dys-AML）在生物学、血液学、免疫表型和细胞遗传学参数以及预后标准方面进行了比较。两组患者的中位年龄均为55岁。在dys-AML中，中位白细胞计数（p = 0.04）、外周血原始细胞（p = 0.02）和骨髓原始细胞计数（p < 0.001）显著降低，而中位血小板计数（p = 0.04）升高。免疫表型分析表明，与非dys-AML中的白血病细胞相比，dys-AML中的白血病原始细胞更频繁地表达黏附分子CD54（p = 0.05）和CD58（p = 0.08）。细胞遗传学方面，我们区分了两种核型模式，一组为正常核型或预后良好的单一染色体畸变（“P(0)核型”），另一组为预后不良的单一畸变或复杂畸变（“P(1)核型”）。dys-AML和非dys-AML之间这两组的发生率无显著差异。诱导化疗后的完全缓解率（CRR，p = 0.03）和总生存时间（OS，p = 0.03）在dys-AML中显著较低。此外，与非dys-AML相比，无病生存期中位值（DFS，p = 无统计学意义）较差。在dys-AML以及非dys-AML患者组中，与P(0)亚组相比，P(1)亚组的CRR、DFS和OS均降低。我们得出结论，造血异常AML具有特定的细胞生物学特征，并且造血和细胞遗传学状态是初发AML中互补的预后因素。
