Predictive or prognostic factors in acute myeloid leukemia

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Predictive or prognostic factors in acute myeloid leukemia

Segunda, 06.11.2017

Acute myeloid leukemia (AML) is a malignant condition with hematopoietic stem cell origin. Citogenetic alterations identified at diagnosis are the most studied prognostic factors and they define risk scores published by international working groups, such as SWOG (Southwestern Oncology Group). The definition of prognostic factors is crucial for the adequate treatment of this condition, with therapeutic implications. The authors of this paper, which includes clinicians from the OncoHematology Department but also researchers from Molecular Oncology and Viral Pathology Group both in IPO Porto, studied a group of AML patients and evaluated the validity of cytogenetic changes as prognostic factors. They concluded that, in the study population, the cytogenetic changes defined by the SWOG group are not prognostic but predictive of response to treatment. However the achievement of complete response with induction treatment has prognostic value.

 


Ana Espírito Santo, Sérgio Chacim, Isabel Ferreira, Luís Leite, Cláudia Moreira, Dulcineia Pereira, Margarida Dantas, Marta Nunes, Luísa Viterbo, Ilídia Moreira, Ãngelo Martins, Isabel Oliveira, Nélson Domingues, José Mariz, Rui Medeiros

Serviço de OncoHematologia, IPO Porto Grupo de Oncologia Molecular e Patologia Viral, IPO Porto, Portugal 

Acute myeloid leukemia (AML) is a clonal hematological malignant condition and the implications of pretreatment risk criteria as predictive or prognostic factors are constantly under evaluation. With this study, the authors' intent was to characterize AML patients and to evaluate the clinical outcome associated with Southwestern Oncology Group (SWOG) coding pretreatment risk criteria/cytogenetic score. Between 2002 and 2010, 225 patients were diagnosed with AML at the Portuguese Institute of Oncology (Porto, Portugal). From this patient group, 128 patients aged <65 years were selected. The patients were treated using a combination of cytarabine and anthracycline, with the addition of cyclosporine when bone marrow dysplasia was observed. A median survival of 24 months was observed in this group. The patients were divided in subgroups according to the SWOG pretreatment risk criteria. We observed a statistically significant association of non favorable SWOG coding with female gender [P=0.025; risk ratio (RR)=3.632, 95% confidence interval (CI): 1.113 11.852], indication for allogeneic bone marrow transplantation (P=0.023, RR=1.317, 95% CI: 1.184 1.465), complete response achievement (P=0.013, RR=1.385, 95% CI: 11.232 1.556) and relapse (P=0.048, RR=3.181, 95% CI: 10.966 10.478). Furthermore, SWOG pretreatment risk criteria also significantly affected global overall survival (OS; P=0.003) and OS at 5 years (P=0.001). A multivariate Cox regression analysis supported response to induction therapy (3 year OS: P=0.011, RR=0.385, 95% CI: 10.184 0.806; 5 year OS: P=0.012, RR=0.388, 95% CI: 10.597 1.994), consolidation (3 year OS: P=0.005, RR=0.328, 95% CI: 0.150 0.720; 5 year OS: P=0.002, RR=0.308, 95% CI: 0.144 0.657) and the diagnosis of therapy related aml (3 year OS: P=0.016, RR=2.756, 95% CI: 0.486 1.281; 5 year OS: P=0.031, RR=2.369, 95% CI: 1.081 5.189) as prognostic factors, but this was not confirmed for SWOG pretreatment risk criteria. Therefore, we concluded that the reproducibility of the application of the SWOG pretreatment risk criteria may not be available as a prognostic factor in every acute leukemia population. However, its application as a predictive factor of response has been confirmed in our population.


Molecular and Clinical Oncology

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