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Evaluation of prognostic factors in patients with relapsed AML: Clonal evolution versus residual disease

대한혈액학회지 2016년 51권 3호 p.175 ~ 180
김효성 ( Kim Hyo-Jeong ) - Pusan National University School of Medicine Pusan National University Hospital Department of Internal Medicine

설영미 ( Seol Young-Mi ) - Pusan National University School of Medicine Pusan National University Hospital Department of Internal Medicine
송무곤 ( Song Moo-Kon ) - Pusan National University School of Medicine Pusan National University Hospital Department of Internal Medicine
최영진 ( Choi Young-Jin ) - Pusan National University School of Medicine Pusan National University Hospital Department of Internal Medicine
신호진 ( Shin Ho-Jin ) - Pusan National University School of Medicine Pusan National University Hospital Department of Internal Medicine
박상혁 ( Park Sang-Hyuk ) - Pusan National University School of Medicine Pusan National University Hospital Department of Laboratory Medicine
이은엽 ( Lee Eun-Yup ) - Pusan National University School of Medicine Pusan National University Hospital Department of Laboratory Medicine
정주섭 ( Chung Joo-Seop ) - Pusan National University School of Medicine Pusan National University Hospital Department of Internal Medicine

Abstract


Background: It is widely known that the prognosis of acute myeloid leukemia (AML) depends on chromosomal abnormalities. The majority of AML patients relapse and experience a dismal disease course despite initial remission.

Methods: We reviewed the medical records and laboratory findings of 55 AML patients who had relapsed between 2004 and 2013 and who had been treated at the Division of Hematology of the Pusan National University Hospital.

Results: The event-free survival (EFS) was related to prognostic karyotype classification at the time of diagnosis and relapse (unfavorable vs. favorable or intermediate karyotypes at diagnosis, 8.2 vs. 11.9 mo, P=0.003; unfavorable vs. favorable or intermediate karyotypes at relapse, 8.2 vs. 11.9 mo, P=0.009). The overall survival (OS) was significantly correlated with karyotype classification only at diagnosis (unfavorable vs. favorable or intermediate vs. karyotypes at diagnosis, 8.5 vs. 21.8 mo, P=0.001; unfavorable vs. favorable or intermediate karyotypes at relapse, 8.5 vs. 21.2 mo, P=0.136). A change in karyotype between diagnosis and relapse, which is regarded as a factor of resistance against treatment, was not a significant prognostic factor for OS, EFS, and post-relapse survival (PRS). A Cox proportional hazards model showed that the combined use of fludarabine, cytosine arabinoside, and granulocyte colony-stimulating factor (FLAG) as a salvage regimen, was a significant prognostic factor for OS (hazard ratio=0.399, P=0.010) and the PRS (hazard ratio=0.447, P=0.031).

Conclusion: The karyotype classification at diagnosis predicts survival including PRS in relapsed AML patients as well as in treatment-naive patients. We suggest that presently, administration of salvage FLAG could be a better treatment option.

키워드

Relapsed AML; Karyotypic change; FLAG regimen
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