Prognostic factors in adult patients with acute leukemia at first relapse

Abstract

The case histories of 252 adolescent and adult patients with acute leukemia diagnosed and treated between 1975 and 1985 are analyzed with special attention to prognostic factors determining the second complete remission (CR) rate. A first CR was achieved in 65% of cases, 60% for acute myelogenous leukemia (AML), and 75% for lymphoblastic leukemia (ALL). In 86 patients a relapse occurred (50 AML, 36 ALL), and 50% of them entered a second CR after reinduction therapy. Median survival after first relapse of these reinduction-responders was significantly prolonged in comparison to the reinduction-nonresponders for both AML (15 versus 2 months) and ALL (11 versus 3 months). Median duration of the first CR of the reinduction-responders was significantly longer than that of the second CR (13 versus 6 months). The major determinant for the probability to obtain a second CR after reinduction therapy was the duration of the first CR. The latter was significantly longer in the reinduction-responders than in the nonresponding group (13 versus 5 months). Furthermore patients younger than 40 years, and those who relapsed after ending the maintenance therapy, tended to have better chances to achieve a second CR. Rapid achievement of the first CR, and sex of the patients seemed not to be of predictive value. The authors conclude that aiming for a second CR is worthwhile in young patients who relapse after a long first CR.

Impact of cytogenetics on the prognosis of adults with de novo AML in first relapse

“…27,29,39,40 In accordance with many previous studies, we confirmed that the duration of first CR is an important prognostic factor for the achievement of second CR, the duration of OS and DFS from second CR. [21][22][23][24] There was a significant relation between the duration of first CR and the parameters of clinical outcome (rate of second CR, OS and DFS). Since the cytogenetic risk category may exert an influence on the effect of the duration of first remission on the outcome after relapse, we analysed the interaction of both parameters.…”

“…[17][18][19][20] It has been shown that both the chance to achieve a second CR and the long-term outcome strongly depend on the duration of first remission. [21][22][23][24] Kantarjian et al 25 were the first to address the issue of the prognostic value of cytogenetics in patients with AML in relapse. They reported that a favourable karyotype was more frequent in patients whose first remissions were at least 12 months, while the opposite was found in patients with an unfavourable karyotype.…”

Multivariate analysis of prognostic factors in patients with refractory and relapsed acute myeloid leukemia undergoing sequential high-dose cytosine arabinoside and mitoxantrone (S-HAM) salvage therapy: relevance of cytogenetic abnormalities

“…[32][33][34][35][36][37][38][39][40][41][42] Thus, on the basis of the current analyses, the assignment of salvage regimens to patients with refractory and relapsed AML should be stratified not only with regard to the duration of the first CR but also with regard to chromosome abnormalities. Further patients should be evaluated to add to the current data and also to clarify the role of chromosome abnormalities determined directly prior to salvage therapy which are different to the initial karyotype in about 60% of cases.…”

Identification of drug-resistant myeloid leukemic cells by measurement of DNA content, nuclear area, and detection of P-glycoprotein

“…The nuclear outline of these cells was irregular and a perinucleolar halo was observed around prominent nucleoli. The leukemic cells of Patients 3, 5, 6,9,11,21, and 23-25 changed in morphology once and those of Patients 4,8,[13][14][15][16]20,22,27,and 28 Patient 4 achieved a complete remission. However, the leukemic cells at the first relapse were large in size and had lobulated nuclei (Fig.…”

“…The newly emerged DRMLC in all patients showed an aneuploidy DNA pattern, except for Patients 10 and 12. The leukemic cells of Patients 4,8,[13][14][15][16]20,22,27, and 28 changed twice in morphology after the diagnosis of AML or BC, and the 2 DI values of the newly emerged leukemic DNA stem lines in these patients were different from each other. With regard to the DRMLC that proliferated in the bone marrow just before death (Patient 12 is still alive), the frequency of DNA aneuploidy was 92.8% (26 of28 patients) and diploid was present in 7.1% (2 of 28 patients).…”