High-Resolution Chromosomes as an Independent Prognostic Indicator in Adult Acute Nonlymphocytic Leukemia

• Published in: The New England journal of medicine Vol. 311; no. 13; pp. 812 - 818
• Main Authors: Yunis, Jorge J, Brunning, Richard D, Howe, Robert B, Lobell, Michael
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 27.09.1984
• Subjects: Acute Disease; Adolescent; Adult; Age; Age Factors; Aged; Biological and medical sciences; Bone marrow; Bone Marrow - pathology; Cancer therapies; Chemotherapy; Chromosome Aberrations; Chromosome Inversion; Chromosomes; Cloning; Female; Hematologic and hematopoietic diseases; Hospitals; Humans; Karyotyping; Laboratories; Leukemia; Leukemia - genetics; Leukemia - mortality; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical prognosis; Medical sciences; Middle Aged; Prognosis; Remission; Survival; Survival analysis; Translocation, Genetic; Trisomy; Chromosomal aberration; Human; Prognosis; Acute; Cytogenetics; Bone marrow; Adult; Chromosome; Hemopathy; Nonlymphocytic leukemia
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM198409273111302

Using high-resolution chromosomes of bone-marrow specimens from 105 consecutive adult patients with de novo acute nonlymphocytic leukemia, we found an unusually high degree of complexity in this disorder, which may explain previous difficulties in identifying useful prognostic indicators. Specimens from 99 of the 105 patients were successfully analyzed, and 92 (93 per cent) had a chromosomal defect. Seventeen categories were identified, 12 representing a specific recurrent defect. Three of them have been found to have independent prognostic importance. Patients with an inversion 16 (9 per cent), diagnosed as having M2, M4, or M5b disease according to the morphologic classification of the French–American–British Acute Leukemia Cooperative Study Group, had a uniform and sustained complete remission and a median survival of 25 months. In contrast, 14 patients (14 percent) with complex chromosomal abnormalities and a diagnosis of M1, M2, M4, M5a, or M6 disease had a very poor prognosis. In 12 of the 14 patients efforts to achieve induction of remission failed, and the group had a median survival of 2.5 months. A third group with a trisomy 8 as the single defect (11 per cent) had an intermediate prognosis and a median survival of 10 months. With the different types of treatment for acute nonlymphocytic leukemia that are now available, we suggest that high-resolution chromosome analysis will become an important tool in selecting specific types of therapy for groups of patients with differing prognoses. (N Engl J Med 1984; 311:812–8.) LESS than 30 years ago, acute nonlymphocytic leukemia (ANLL) was regarded as incurable, and patients with the disorder had an average survival of only a few months. 1 Today, with new therapeutic approaches and improved management of the disease, it is possible to induce complete remission in 50 to 80 per cent of patients, and 10 to 20 per cent are long-term survivors. 1 In spite of these advances, however, the median survival is still less than a year, and it has not been possible to predict accurately which patients will have a short, intermediate, or long survival, using standard cytologic and . . .