急性髓系白血病伴Inv(16)/t(16;16)的临床分析

目的:探讨影响急性髓系白血病(AML)伴Inv(16)/t(16;16)患者临床特征、细胞遗传学特点以及生存、预后的主要因素。方法:对43例AML伴Inv(16)/t(16;16)患者进行总结分析、随访,了解一般情况、免疫分型、染色体核型及治疗、生存情况,对影响总体生存时间、无复发生存时间的因素进行统计学分析。结果:43例AML伴Inv(16)/t(16;16)患者总完全缓解(CR)率97.5%,1疗程CR率92.6%。所有患者的中位总生存时间(OS)未达(0.33～81.9个月),中位无复发生存(RFS)63.4(3.02～81.9)个月。3年OS率69%,5年OS率56%;3年RFS率68%,5年RFS率43%。统计学分析可见:≥45岁的患者与45岁患者相比较OS、RFS期短,预后差。发病时一般特征、染色体核型及巩固治疗过程中采用中剂量Ara-C治疗的疗程数与OS无关。结论:年龄≥45岁是AML伴Inv(16)/t(16;16)的主要预后不良因素。     

老年急性髓系白血病诱导治疗的疗效及预后

目的探讨老年急性髓系白血病(AML)患者诱导治疗的疗效差异及预后影响因素。方法回顾性分析65例初治老年(年龄≥60岁)AML患者[非急性早幼粒细胞白血病(APL)]的临床资料。45例患者接受以阿糖胞苷(Ara-C)为基础的诱导缓解化疗方案,其中标准剂量Ara-C方案组21例,小剂量Ara-C方案组24例;姑息治疗组为20例。比较化疗和姑息治疗患者的疗效,并对预后进行单因素和多因素分析。结果标准剂量Ara-C方案组完全缓解(CR)率为52.4%(11/21),小剂量Ara-C方案组CR率为41.7%(10/24),两组差异无统计学意义(P0.05)。两组总生存(OS)率分别为33.3%(7/21)和25%(6/24),差异无统计学意义(P0.05),6个月无病生存(DFS)率分别为38.1%(8/21)和29.2%(7/24),差异无统计学意义(P0.05)。化疗组与姑息治疗组中位生存时间分别为16.27个月和3个月(P0.05),两组总OS率分别为28.9%(13/45)和5%(1/20),差异有统计学意义(P0.05);化疗组早期死亡率8.9%(4/45),姑息治疗组早期死亡率20%(4/20),无统计学意义(P0.05)。COX多因素分析显示,白细胞计数≥100.0×10~9/L(RR:2.873,95%CI:1.383～5.968)、ECOG评分≥3分(RR:2.066,95%CI:1.051～4.059)、预后不良染色体核型(RR:2.465,95%CI:1.355～4.485)、是否接受诱导缓解化疗(RR:0.329,95%CI:0.157～0.689)是老年AML患者预后的独立危险因素。白细胞计数≥100×10~9/L(OR:10.208,95%CI:2.031～51.313)是老年AML患者早期死亡的独立危险因素。结论诱导缓解化疗未增加早期死亡率,可延长生存,小剂量Ara-C方案可作为老年及不适合标准方案化疗的AML患者的一线选择。     

急性红白血病55例染色体特征和预后分析

目的探讨急性红白血病（M6）染色体特征和预后因素。方法回顾性分析55例患者染色体核型特征,采用病例对照方法,分为原发组和骨髓增生异常综合征（MDS）转化组;染色体核型异常组和正常组,并分析各组异基因造血干细胞移植（all-HSCT）治疗和（或）化疗疗效及生存预后因素。结果45例经染色体检查,18例正常,染色体异常检出率为60．0％（27／45）,其中复杂异常17例,简单异常10例,10例可见亚二倍体或超二倍体明显增多,18．5％（5／27）5号染色体受累,25．9％（7／27）7号或8号染色体受累。55例患者完全缓解（CR）率63．6％;MDS转化组CR率（42．8％）显著低于原发组（85．2％）,P〈0．05;染色体核型异常组CR率（37．0％）显著低于正常组（83．3％）,P〈0．01。生存预后因素：随访中位时间30（3—79）个月,染色体核型异常组和MDS转化M6患者生存期（OS）和无病生存期（DFS）,移植治疗者较化疗者显著延长（P〈0．01）。16例患者行all-HSCT治疗,其中9例为染色体核型异常MDS转化M6患者,4例为未缓解患者;移植后11例DFS 28个月,2年生存率68．7％（11／16）。结论染色体核型异常和（或）MDS转化M6患者常规化疗疗效差、生存期短,预后差,all-HSCT治疗显著延长生存期,改善预后,染色体核型异常和（或）MDS转化M6患者,宜早期all-HSCT治疗。     

血浆纤维蛋白原水平与非M3型急性髓性白血病患者的预后和疗效的相关性研究

目的:探讨血浆纤维蛋白原(Fg)水平在预测非M3型急性髓性白血病(AML)的生存预后和诱导化疗疗效的临床价值。方法:回顾性分析215例初治非M3型AML患者的血浆Fg水平和化疗疗效,根据ROC曲线确定Fg阈值,比较不同Fg水平的非M3型AML患者的总生存期(OS)和无病生存期(DFS)差异,并确定影响非M3型AML患者OS和DFS的独立危险因素。结果:ROC曲线确定AML患者Fg水平高低分组临界值为3.8 g/L,共有114例患者Fg3.8 g/L,101例患者Fg≥3.8 g/L。与Fg3.8 g/L患者相比,Fg≥3.8 g/L患者的诱导化疗后的完全缓解(CR)率更低(70.3%vs 86.0%,P=0.005),但复发率更高(44.6%vs 29.8%,P=0.025)。而CR患者的血浆Fg水平显著低于未达到CR患者的血浆Fg水平[(3.6±1.1) g/L vs (4.1±1.2) g/L,P=0.009]。复发患者的血浆Fg水平显著高于未复发患者的血浆Fg水平[(4.3±1.5) g/L vs (3.7±1.2) g/L,P=0.001]。与Fg3.8 g/L患者相比,Fg≥3.8 g/L患者的DFS和OS均明显缩短(均P0.001)。单因素及多因素Cox回归分析显示,年龄≥60岁(HR=1.239,95%CI 1.113～1.496,P=0.005)、TT16 s(HR=1.288,95%CI 1.139～1.871,P=0.046)和Fg≥3.8 g/L(HR=1.763,95%CI 1.399～2.984,P=0.003)是影响非M3型AML患者DFS缩短的独立危险因素;而年龄≥60岁(HR=1.223,95%CI 1.074～1.532,P=0.026)、血红蛋白100 g/L(HR=1.654,95%CI 1.234～2.273,P=0.025)和Fg≥3.8 g/L(HR=2.134,95%CI 1.238～3.943,P=0.010)是影响非M3型AML患者OS缩短的独立危险因素。结论:初治非M3型AML患者治疗前血浆Fg水平可作为预测OS和DFS的独立危险因素,也可有效预测诱导化疗疗效和复发风险。     

85例18岁以下急性髓细胞白血病的疗效分析

目的研究初治18岁以下急性髓细胞白血病(AML)的疗效及影响因素,以期进一步提高儿童AML无病生存(DFS)率。方法回顾性研究分析85例年龄18岁以下AML患者的疗效,采用Kaplan-Meier生存曲线评估患者的无病生存(DFS),单因素分析用Log-rank检验,多因素分析用Cox回归模型。结果85例患者中,1个疗程完全缓解(CR)者46例(54.1%),总CR率为75.3%。4年累积DFS率(25.8±9.7)%,4年累积复发率(73.9±9.9)%。单因素分析显示血红蛋白≥90g/L、>1个疗程达CR及巩固疗程<6个是影响患者DFS的危险因素。多因素分析显示初诊时骨髓白血病细胞比例>60%、>1个疗程达CR及巩固疗程<6个与患者DFS期短显著相关(P<0.05)。同时具有1个疗程达CR和巩固疗程≥6个的患者4年累积DFS率(49.5±16.3)%。结论骨髓原始细胞比例≤60%和1个疗程达CR及巩固疗程≥6个的18岁以下AML患者DFS期显著延长。     

难治性急性髓系白血病异基因造血干细胞移植治疗疗效分析

目的 :评价异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)治疗复发难治性急性髓系白血病(refractory acute myeloid leukemia,r AML)的疗效。方法:收集2000年1月至2015年6月在上海交通大学医学院附属瑞金医院和海军医科大学附属长海医院接受allo-HSCT治疗的r AML患者73例,按移植前疾病状态分为完全缓解(complete remission,CR)组(44例)和未缓解(non-remission,NR)组(29例),随访截止时间2015年12月31日,分析allo-HSCT后非复发死亡率(non-relapsing mortality,NRM)、粒细胞及血小板植入时间、移植物抗宿主病(graft versus host disease,GVHD)发生率、2年总生存(overall survival,OS)率、2年无病生存(disease-free survival,DFS)率等数据。结果 :所有患者移植后获得造血功能重建,中位随访时间470(230.5,1 011.5)d。所有患者2年OS率为56.5%,2年DFS率为41.8%。移植前CR组和NR组2年OS率分别为64.0%和45.6%(P=0.345),2年DFS率分别为45.6%和35.6%(P=0.393);移植前CR组和NR组NRM、粒细胞及血小板植入时间、GVHD发生率差异均无统计学意义。结论:allo-HSCT是治疗r AML的有效治疗手段,长期DFS为41.8%,移植前疾病状态是否达到CR对移植后的预后无显著影响。     

急性髓细胞白血病表达CD7抗原的临床意义以及与细胞遗传学的相关性

目的：了解急性髓细胞白血病（AML）表达CD7抗原的临床意义以及与细胞遗传学的相关性。方法：对我院诊治的52例AML患者的免疫表型、细胞遗传学以及临床特点进行分析。结果：15例（28．8％）患者的骨髓白血病细胞表达CD7抗原。根据FAB分型,M2（18．5％）和M。型（20％）的CD7^＋率较低。CD7^＋组早期细胞抗原CD34、HLA—DR、CD117的表达率以及老年患者（大于60岁）比例高于CD7^-组,白细胞计数、染色体异常率、肝脾肿大及髓外白血病发生率均低于CD7^-组。CD7^＋组完全缓解（CR）率高于CD7^-组,无病生存期（DFS）短于CD7组,但差异均无统计学意义（P〉0．05）。70％以上的CD7^＋ AML患者分布在中等预后核型组。随着预后好、预后中等、预后差核型组的变化,AML所有病例、CD7^-组、CD7^＋组的CR率均呈逐渐下降趋势。结论：与CD7^- AML相比,CD7^＋ AML更容易获得CR,可能与低的白细胞计数、低的染色体异常率以及低的肝脾肿大与髓外白血病发生率有关;CD7^＋ AML患者年龄较大或同时表达早期细胞抗原,可能影响DFS。AML无论是否表达CD7抗原,染色体核型是判断预后最重要的因素。     

不同诱导化疗方案对成人急性淋巴细胞白血病疗效的影响

目的：比较成人急性淋巴细胞白血病（ALL）患者不同诱导化疗方案治疗的疗效。方法：回顾性分析医科院血液病医院从1998年6月—2008年1月新诊断、治疗的ALL患者124例。采用SPSS13.0统计学软件分析有关数据。结果：①根据诱导治疗方案分为VDCLP、VDCP2组,2组的1疗程CR率为87.9%和84.5%,总CR为93.9%和89.7%。VDCLP组中位无病生存（DFS）21（0～116）个月,中位总生存（OS）23（2～117）个月;VDCP组中位DFS10（0～109）个月,中位OS14（1～110）个月。2组的3年DFS分别为55.2%和19.2%。2组的3年OS率56.2%和21.1%,（P〈0.05）。②≤30岁的青少年和年轻成人ALL采用VDCLP和VDCP方案1疗程CR率分别为92.7%和86.8%,总CR率分别为97.6%和94.7%。VDCLP组中位DFS23（0～116）个月,中位OS24（2～117）个月;VDCP组中位DFS10（0～109）个月、中位OS14（1～110）个月。2组的3年DFS分别为60.4%和18.2%。2组的3年OS率62.9%和20.9%。③采用VDCLP方案诱导治疗的染色体核型标危组成人ALL,VDCLP组中位DFS22（0～116）个月、中位OS24（3～117）个月;VDCP方案诱导治疗中位DFS13（0～109）个月、中位OS19（1～110）个月。2组的3年DFS分别为59.0%和DFS23.3%。2组的3年OS率60.7%和29.8%。而染色体核型高危成人ALL,VDCLP组中位DFS6（0～32）个月,中位OS17（2～38）个月;VDCP组中位DFS8（0～20）个月,中位OS10（5～23）个月。2组的3年DFS分别为0.0%和DFS0.0%。2组的3年OS率0.0%和0.0%。结论：诱导治疗中加L-Asp对CR率无明显影响,但诱导治疗采用VDCLP较VDCP可以提高成人ALL的DFS和OS。     

CAG方案治疗老年初治急性髓性细胞白血病疗效观察

目的比较CAG预激方案与常规化疗治疗老年初治急性髓性细胞白血病(AML)的疗效。方法 32例老年初治AML患者,随机分为治疗组及对照组,治疗组予以CAG预激方案治疗,对照组予以常规柔红霉素+阿糖胞苷(DA)或高三尖杉酯碱+阿糖胞苷(HA)等方案治疗。均治疗2个疗程后评定疗效。根据染色体核型分析评估预后,比较两组治疗后3年无病生存率(DFS)。结果治疗组及对照组治疗总有效率分别为81.3%、50.0%(P<0.05)。治疗组中性粒细胞缺乏、血小板减少发生率及持续时间均明显少于对照组(P均<0.05)。治疗组预后良好及预后中等者CR例数、3年DFS高于对照组(P均<0.05)。两组中预后差者3年DFS均为0。结论 CAG预激方案治疗老年初治AML患者较传统常规治疗具有疾病完全缓解率及有效率高、不良反应小等优点。     

老年急性髓系白血病预后影响因素的Cox分析

目的 探讨影响老年急性髓系白血病(AML)患者的预后因素.方法 回顾我院1997年～2008年收治的67例老年AML患者,就可能影响预后的因素进行单因素的Kaplan-Meier生存分析,对有意义的因素进行Cox 比例风险模型评估.结果 全部患者的中位生存期为4.2个月,完全缓解(CR)率为29.9%,获CR的中位生存期为7.5个月.单因素生存分析显示高年龄(＞70岁)、体能状况评分差(ECOG 2～4)、继发性AML、有并发症、初治时的白细胞数高(＞50×109/L)、骨髓原始细胞比率高(＞50%)、非标准化疗方案及白细胞CD34阳性取得相对较短的生存期(P＜0.05).多因素Cox模型分析显示年龄、有无并发症、体能状况(PS)、初治时的白细胞数及化疗方案为影响预后的独立因素(P＜0.05).结论 老年AML患者的预后受多因素影响,CR率低,长期生存率低,预后差.     

老年急性白血病患者50例临床特征分析

目的:探讨老年急性白血病(AL)的临床特点,以利于有效治疗。方法:回顾分析50例60岁以上的老年AL患者的临床资料,包括年龄分布、基础疾病、主要症状、临床特征、骨髓(BM)象、染色体、免疫分型、化疗的完全缓解(CR)率、BM抑制程度、病程及病死率。并与同期住院的66例中青年患者进行比较。结果:老年AL发病率占同期成人AL的27%(50/185)。AML的CR率35.7%(15/42),ALL的CR率33%(2/6)。其基础疾病的发病率86%、MDS转化为AML占20%、病程(35.5±16.5)d、BM抑制时间(18.5±6.5)d、病死率20%、染色体核型为-5、-7、+8、+21,以上均高于同期的中青年组(均为P<0.01)。结论:老年AL患者并存基础疾病和染色体核型异常是其病死率高的主要原因,目前尚无早期诊断和有效治疗老年AL的满意策略,呼吁重视此方面的研究。     

骨髓增生异常综合征RAEB、RAEB-T和老年急性髓系白血病的临床对照分析

目的：在WHO分类中,FAB分型中的骨髓增生异常综合征一难治性贫血伴原始细胞增多转化型（MDS—RAEBT）被划分为急性髓系白血病（AML）,本文探讨该划分的合理性。方法：采用病例对照研究比较58例老年AML患者、88例骨髓增生异常综合征-难治性贫血伴原始细胞增多（MDS-RAEB）10％～19％（骨髓原始细胞10％～19％）患者和37例MDS-RAEBT患者在临床和染色体核型及共同累及的染色体异常类型上的区别。结果：MDS-RAEBT和MDS-RAEB在病程、WBC、Hb、肝脾肿大比例、正常核型和复杂核型比例及共同累及的染色体异常类型上差异无统计学意义,而和老年AMI,患者比较差异有统计学意义。结论：MDS-RAEBT应该划分为MDS,该结论有待于前瞻性实验进一步验证。     

Characterization and prognostic features of secondary acute myeloid leukemia in a population‐based setting: A report from the Swedish Acute Leukemia Registry

Patients with secondary acute myeloid leukemia (AML) often escape inclusion in clinical trials and thus, population‐based studies are crucial for its accurate characterization. In this first large population‐based study on secondary AML, we studied AML with an antecedent hematological disease (AHD‐AML) or therapy‐related AML (t‐AML) in the population‐based Swedish Acute Leukemia Registry. The study included 3,363 adult patients of which 2,474 (73.6%) had de novo AML, 630 (18.7%) AHD‐AML, and 259 (7.7%) t‐AML. Secondary AML differed significantly compared to de novo AML with respect to age, gender, and cytogenetic risk. Complete remission (CR) rates were significantly lower but early death rates similar in secondary AML. In a multivariable analysis, AHD‐AML (HR 1.51; 95% CI 1.26–1.79) and t‐AML (1.72; 1.38–2.15) were independent risk factors for poor survival. The negative impact of AHD‐AML and t‐AML on survival was highly age dependent with a considerable impact in younger patients, but without independent prognostic value in the elderly. Although patients with secondary leukemia did poorly with intensive treatment, early death rates and survival were significantly worse with palliative treatment. We conclude that secondary AML in a population‐based setting has a striking impact on survival in younger AML patients, whereas it lacks prognostic value among the elderly patients. Am. J. Hematol. 90:208–214, 2015. © 2014 Wiley Periodicals, Inc.     

地西他滨单药或联合低剂量化疗治疗老年急性髓系白血病医院内感染的临床分析

目的分析地西他滨单药或联合低剂量化疗治疗老年急性髓系白血病医院内感染的临床特点及易感因素。方法回顾性分析2009年9月至2012年10月接受地西他滨单药或联合低剂量化疗治疗的10例老年急性髓系白血病患者医院内感染发生率、感染部位、致病菌和易感因素等。结果10例老年患者治疗后医院内感染率为70％,例次感染率为46．7％,感染部位以呼吸系统最多见（占52．4％）,致病菌以革兰阴性杆菌为主。化疗后骨髓抑制、粒细胞减少者感染率明显增高;与地西他滨联合低剂量化疗方案比较,地西他滨单药方案骨髓抑制、粒细胞减少发生率和医院内感染率降低。结论老年急性髓系白血病患者是医院内感染的易感人群,骨髓抑制、粒细胞减少是其易感因素。地西他滨单药方案治疗老年急性髓系白血病可降低医院内感染发生率。     

Clinical results and issues of acute myeloid leukemia in elderly patients aged 75 years and older

Aim: Clinical outcomes of acute myeloid leukemia (AML) in elderly patients still remain unsatisfactory and the optimal treatment has yet to be clearly established. This report describes the results of a retrospective study of clinical outcomes and prognostic factors of AML in patients aged 75 years and older. In addition, we aimed to elucidate the situation of patients with AML accompanied by dementia, which has been largely ignored in previous studies. Methods: The subjects consisted of 31 patients with untreated AML (including previous myelodysplastic syndrome: AML/MDS). All patients underwent chemotherapy, with 25 undergoing conventional therapy and six undergoing low‐intensity therapy. Results: Complete remission was obtained in 16 of the 31 cases (51.6%), with a 3‐year survival rate of 11.5%. However, in seven cases, Alzheimer's disease (AD) was observed. Although we were able to perform induction therapy in each of these cases, consolidation therapy was difficult in cases of moderate AD. Conclusion: The results of this study suggest that even very elderly patients can benefit from chemotherapy. However, it is thought that the treatment selection for cases which are complicated by moderate to severe dementia should be determined carefully while considering the patient's quality of life. Geriatr Gerontol Int 2011; 11: 290–296 .     

Retrospective study of acute myelogenous leukemia in 83 elderly patients: clinical and biological characteristics

In order to characterize clinical and biological characteristics of elderly patients with acute myelogenous leukemia (AML), we retrospectively analysed 83 elderly patients aged 60 years or more and, as a control, 114 younger patients aged 15 to 59 years who were admitted to our hospital between August 1984 and January 1998. There was a significantly higher incidence of preceding myelodysplastic syndromes in the elderly patients. They also had a significantly higher incidence of unfavorable cytogenetic abnormalities (loss or partial deletion of chromosome 5 or 7) and a significantly lower incidence of favorable cytogenetic abnormalities, such as t(15:17), t(8:21), or inv(16). With regard to FAB subtypes in de novo AML, the incidence of M3 subtype was significantly lower in the elderly group. Myeloperoxidase positivity of AML cells in the elderly group was lower than that in the younger group. Laboratory data at presentation disclosed a lower peripheral leukemic cell count, a higher fibrinogen level, a lower serum protein level, and a higher serum creatinine level in the elderly group. They also had poorer performance status and more frequent concomitant diseases at presentation, including liver diseases, heart diseases, or documented infections. It was concluded that elderly AML patients 60 years or older had a higher incidence of poor prognostic factors compared to younger patients.     

老年人急性髓系白血病临床特点及疗效分析

目的 探讨老年人急性髓系白血病(AML)的临床特点及生物学特征.方法 回顾性分析62例60岁以上AML患者的临床资料,并与同期住院的60例中青年患者进行比较.结果 老年组完全缓解率27.7%,总有效率44.7%,中青年组分别为74.1%和87.9%(P＜0.01).老年组早期病死率19.0%,诱导期病死率29.3%,均高于中青年组(3.3%和6.7%,P＜0.01).老年组伴骨髓增生异常综合征(MDS)病史者占27.4%,中青年组仅10.0%(P＜0.05),继发于MDS的AML患者CR率低于无MDS病史者(P＜0.05).老年组伴淋系抗原表达者占28.2%,CD34+者占71.8%,均高于中青年组(8.1%和48.6%,P＜0.05),其CR率均低于仅有髓系抗原表达者和CD34-者(P＜0.05).老年组预后不良核型发生率高于中青年组(分别为45.7%和15.4%,P＜0.05).结论 老年AML患者具有多种不良预后因素,总体缓解率低,病死率高,在临床上有其特殊性,治疗上更强调个体化.     

CD90/Thy-1 is preferentially expressed on blast cells of high risk acute myeloid leukaemias

Different transformation mechanisms have been proposed for elderly acute myeloid leukaemia (AML) and secondary AML (sAML) when compared with de novo AML or AML of younger patients. However, little is known regarding differences in the immunophenotypic profile of blast cells in these diseases. We systematically analysed, by flow cytometry, 148 patients affected by de novo (100 cases) or sAML (48 cases). By defining a cut-off level of 20% of CD34+ cells co-expressing CD90, the frequency of CD90+ cases was higher in sAML (40%) versus de novo AML (6%, P < 0.001), elderly AML (>60 years) (24%) versus AML of younger patients (10%, P = 0.010) and poor- versus good-risk karyotypes (according to the Medical Research Council classification, P < 0.001). The correlation between CD90 expression, sAML and unfavourable karyotypes was confirmed by analysing the subset of CD34+ AML cases alone (91/148). Consistently, univariate analysis showed that expression of CD90 was statistically relevant in predicting a shorter survival in CD90+ AML patients (P = 0.042). Our results, demonstrating CD90 expression in AML with unfavourable clinical and biological features, suggest an origin of these diseases from a CD90-expressing haemopoietic progenitor and indicate the use of CD90 as an additional marker of prognostic value in AML.     

Clinical impact of internal tandem duplications and activating point mutations in FLT3 in acute myeloid leukemia in elderly patients

BACKGROUND: The FLT3 gene is frequently mutated in acute myeloid leukemia (AML), either by an internal tandem duplication (ITD) of the juxtamembrane domain or by activating point mutations in the second tyrosine kinase domain (ATKD). Only a few investigations have focused on the prognostic significance of FLT3 alterations in AML among the elderly, yielding conflicting results. In the present study, the frequency and clinical relevance of FLT3 abnormalities were ascertained in a cohort of elderly AML patients. PATIENTS AND METHODS: A total of 109 AMLs, occurring in patients above the age of 60 yr (median 71.5), were investigated. DNA was extracted from fresh bone marrow cells or from cells in fixative and investigated for the presence of ITD of exons 14 and 15 and the ATKD D835 in exon 20. RESULTS: ITDs and ATKDs were identified in 20 (18%) and 11 (10%) of the cases, respectively. Three cases displayed both an ITD and an ATKD. FLT3 abnormalities were associated with leukocytosis (ITD P < 0.01; ATKD P = 0.069), and the monocytic FAB subtypes M4 and M5 [ITD (P < 0.05), ATKD (P = 0.05)], and ITD and ATKD were significantly (P < 0.05) more common in cases with a normal karyotype. There was no correlation between the presence of FLT3 abnormalities and complete remission rates or overall survival. CONCLUSION: A correlation was observed between FLT3 abnormalities and leukocytosis, a normal karyotype, and the M4/M5 subtypes of leukemia. However, no clear-cut prognostic impact of FLT3 abnormalities was identified in elderly AML patients.     

Aggressive salvage treatment is not appropriate for the majority of elderly patients with acute myeloid leukemia relapsed from first complete remission

BACKGROUND AND OBJECTIVES: The prognosis of acute myeloid leukemia (AML) in the elderly is still poor because of different reasons, including a high incidence of relapse. The aim of this study was to investigate whether aggressive salvage chemotherapy (CHT) results in an actual survival advantage in elderly patients with relapsed AML, as well as to compare hospitalization and load of supportive treatment between patients receiving aggressive management or only palliation. DESIGN AND METHODS: One hundred and fifty consecutive patients with relapsed AML (median age 66 years) were analyzed. At relapse, 99 (66%) were treated with CHT, and 51 had palliative management. RESULTS: Second complete remission (CR2) was achieved in 36/99 patients (36%) receiving CHT, while no CR was observed in the other group (p<0.001). Induction death rate was 22%, while 41% were resistant to CHT. The median survival from relapse was 4 months for the whole patient population; according to management, it was 5 months and 3 months for CHT and palliation, respectively (p=0.01). As to patients given CHT, a CR1 duration of more than 12 months was the only parameter significantly related to a better clinical outcome (survival from relapse: 8 vs. 4 months, p=0.002; CR2 duration: 11 vs. 5 months, p=0.001, respectively). Finally, patients managed with palliation required less hospitalization and less supportive therapy as compared to the CHT group. INTERPRETATION AND CONCLUSIONS: Aggressive chemotherapy results in an actual survival advantage only for a minority of elderly patients with relapsed AML, i.e. those with CR1 lasting for more than 12 months.