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Blood, 15 November 2006, Vol. 108, No. 10, pp. 3280-3288.
Prepublished online as a Blood First Edition Paper on July 13, 2006; DOI 10.1182/blood-2006-04-014324.
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CLINICAL TRIALS AND OBSERVATIONS
Cytogenetics and age are major determinants of outcome in intensively treated acute myeloid leukemia patients older than 60 years: results from AMLSG trial AML HD98-B
Stefan Fröhling,
Richard F. Schlenk,
Sabine Kayser,
Martina Morhardt,
Axel Benner,
Konstanze Döhner,
Hartmut Döhner, for the German-Austrian AML Study Group
From the Department of Internal Medicine III, University Hospital of Ulm; and Central Unit Biostatistics, German Cancer Research Center, Heidelberg, Germany.
To assess the prognostic impact of cytogenetics in elderly patients with acute myeloid leukemia (AML) receiving intensive induction and consolidation treatment according to a single protocol specifically designed for patients above age 60, pretreatment samples from 361 patients registered for the AML HD98-B trial of the German-Austrian AML Study Group were analyzed by chromosome banding and fluorescence in situ hybridization, and cytogenetic findings were correlated with outcome. Using a proportional hazards model with backward selection, 3 prognostic subgroups were identified based on the influence of cytogenetic abnormalities on overall survival (OS): low-risk, t(15;17), and inv(16) in 25 of 361 patients (7%); standard-risk, normal karyotype, t(8;21), t(11q23), +8 within a noncomplex karyotype, and +11 within a noncomplex karyotype in 208 of 361 patients (58%); high-risk, all other aberrations in 128 of 361 patients (35%). On multivariate analysis, high-risk cytogenetics (hazard ratio [HR], 2.24) and age above 70 years (HR, 2.34) were independent prognostic factors affecting OS, and stratification according to these parameters demonstrated that a large subgroup of patients (55%), characterized by age 70 or older or high-risk cytogenetics, or both, had very unfavorable treatment results despite intensive chemotherapy. Thus, karyotype and age are major determinants of outcome in elderly patients with AML.

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