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Blood, 15 May 2002, Vol. 99, No. 10, pp. 3517-3523
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
A white blood cell index as the main prognostic factor in t(8;21)
acute myeloid leukemia (AML): a survey of 161 cases from the French
AML Intergroup
Stéphanie Nguyen,
Thierry Leblanc,
Pierre Fenaux,
Francis Witz,
Didier Blaise,
Arnaud Pigneux,
Xavier Thomas,
Françoise Rigal-Huguet,
Bruno Lioure,
Anne Auvrignon,
Denis Fière,
Josy Reiffers,
Sylvie Castaigne,
Guy Leverger,
Jean-Luc Harousseau,
Gérard Socié, and
Hervé Dombret for the
French AML Intergroup including the Groupe Ouest Est Leucémies
Aiguës Myéloblastiques (GOELAM), the Leucémies
Aiguës Myéloblastiques de l'Enfant (LAME), the Acute
Leukemia French Association (ALFA), and the Bordeaux Grenoble Marseille
Toulouse (BGMT) cooperative groups
From the Department of Hematology, Hôpital
Saint-Louis; and Department of Hematology, Hôpital Trousseau;
both of Paris, France; Department of Hematology, Hôpital Claude
Huriez, Lille, France; Department of Hematology, Hôpital Brabois,
Nancy, France; Department of Hematology, Institut Paoli-Calmettes,
Marseille, France; Department of Hematology, Hôpital du
Haut-Lévèque, Pessac, France; Department of Hematology,
Hôpital Edouard Herriot, Lyon, France; Department of Hematology,
Hôpital Purpan, Toulouse, France; Department of Hematology,
Centre Hospitalier de Hautepierre, Strasbourg, France; Department of
Hematology, Hôpital André Mignot, Versailles, France; and
Department of Hematology, CHU Hotel-Dieu, Nantes, France.
While the t(8;21) translocation is one of the most recurrent
chromosomal abnormalities in acute myeloid leukemia, prognostic studies
have been hampered by the relatively few number of patients reported.
We thus performed a large retrospective study in 161 adults and
children with t(8;21) acute myeloid leukemia, all prospectively enrolled in 6 different trials conducted in France between 1987 and
1998 (median follow-up 4.9 years). Prognostic studies were performed in
the 154 patients who achieved a complete remission. Individual data
were registered, including sex, age, blood and marrow counts,
extramedullary disease, and cytogenetics. The value of allogeneic stem
cell transplantation versus chemotherapy as postremission therapy was
evaluated according to the intent-to-treat principle. Estimated 5-year
disease-free survival (DFS) and overall survival were 52% and 59%,
respectively. Outcome was not significantly better in patients from the
stem cell transplantation group (estimated 5-year DFS and
survival, 56% vs 52% and 67% vs 57%; P = .55
and .64, respectively). White blood cell count (WBC) was the only identified prognostic factor. To further take into account the spontaneous differentiation potential of the leukemic clone, a WBC
index was derived as the product of WBC by the ratio of marrow blast.
This WBC index was a more powerful factor than the original WBC,
allowing us to distinguish 3 subgroups of patients with different outcomes (low index, < 2.5; intermediate index, 2.5-20; high index, 20 or more). In multivariate analysis, the WBC index was the only prognostic factor for DFS (P = .003), complete remission
duration (P = .002), and overall survival
(P = .04).
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