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Chromosome aberrations and prognostic factors in therapy-related
myelodysplasia and acute nonlymphocytic leukemia
J Pedersen-Bjergaard, P Philip, SO Larsen, G Jensen and K Byrsting
Department of Internal Medicine and Hematology L, Rigshospitalet,
Copenhagen, Denmark.
Cytogenetic studies of 91 consecutive patients with therapy-related
myelodysplasia or overt acute nonlymphocytic leukemia disclosed
characteristic defects of chromosome 7 in 48 cases and of chromosome 5 in
21 cases. The chromosome 5 abnormalities were consistently present in all
abnormal mitoses at the time of diagnosis, as were the chromosome 7
abnormalities in 45 of the 48 patients. Various abnormalities, primarily of
the short arm of chromosome 17, were observed in 13 cases, abnormalities of
the long arm of chromosome 21 were observed in 12 cases, and rearrangements
of 11q23 were seen in nine cases. Thirteen patients presented a normal
karyotype. Previous therapy with alkylating agents, the presence of an
initial myelodysplastic phase, and abnormalities of chromosome 7 or 5 were
interdependent. Patients with 11q23 rearrangement typically developed overt
leukemia of FAB types M4 or M5a without myelodysplasia and with a short
latent period. Evaluated by Cox regression analysis, complete remission of
the primary malignancy and a malignant lymphoma as primary tumor were the
two most important and independent prognostic factors indicating a longer
survival (P = .008). In addition, the platelet count at diagnosis was a
significant prognostic factor (P = .01). For the subgroup of 62 patients
with myelodysplasia, the number of chromosome aberrations, the percentage
of blasts in the bone marrow, and the hemoglobin level were other
significant and independent prognostic factors (P = .05, .05, and .004,
respectively). The most important predictive factor for a favorable
response to intensive antileukemic chemotherapy in overt leukemia was the
absence of a preceding myelodysplastic phase (P = .0014).
Volume 76,
Issue 6,
pp. 1083-1091,
09/15/1990
Copyright © 1990 by The American Society of Hematology
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