Factores preditivos ou de prognóstico na Leucemia mieloide aguda

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Factores preditivos ou de prognóstico na Leucemia mieloide aguda

Segunda, 06.11.2017

A Leucemia mieloide aguda (LMA) é uma patologia oncológica maligna com origem na célula mãe hematopoiética. As alterações genéticas identificadas ao diagnóstico são os factores de prognóstico mais estudados nesta patologia, existindo escalas de risco definidas por grupos de trabalho internacionais, como é exemplo o grupo SWOG (Southwestern Oncology Group) baseadas nestas alteraçoes. A definição de factores de prognóstico é crucial para o tratamento adequado desta patologia, tendo implicações terapêuticas. Os autores deste trabalho, que inclui clínicos do Serviço de OncoHematologia mas também investigadores do Grupo de Oncologia Molecular do IPO Porto, estudaram um grupo de doentes com LMA tratados neste hospital e avaliaram a validade das alterações citogenéticas como factores de prognóstico. Concluíram que, na população estudada, as alterações citogenéticas definidas pelo grupo SWOG não têm validade prognóstica mas sim preditiva de resposta ao tratamento. No entanto o alcançar de resposta completa com o tratamento de indução tem valor prognóstico.

 


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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