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Prepublished online as a Blood First Edition Paper on March 20, 2003; DOI 10.1182/blood-2002-11-3527.
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Blood, 15 July 2003, Vol. 102, No. 2, pp. 462-469
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Prognosis of inv(16)/t(16;16) acute myeloid leukemia (AML): a survey of 110 cases from the French AML Intergroup
Jacques Delaunay,
Norbert Vey,
Thierry Leblanc,
Pierre Fenaux,
Françoise Rigal-Huguet,
Francis Witz,
Thierry Lamy,
Anne Auvrignon,
Didier Blaise,
Arnaud Pigneux,
Francine Mugneret,
Christian Bastard,
Nicole Dastugue,
Jacqueline Van den Akker,
Denis Fière,
Josy Reiffers,
Sylvie Castaigne,
Guy Leverger,
Jean-Luc Harousseau, and
Hervé Dombret, for the French Acute Myeloid Leukemia (AML) Intergroup including the Groupe Ouest-Est des 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, Paris; Department of Hematology, Institut Paoli-Calmettes, Marseille; Department of Hematology, Hôpital Claude Huriez, Lille; Department of Hematology, Hôpital Purpan, Toulouse; Department of Hematology, Hôpital Brabois, Nancy; Department of Hematology, Centre Hospitalier Pontchaillou, Rennes; Department of Hematology, Hôpital Trousseau, Paris; Department of Hematology, Hôpital du Haut-Lévèque, Pessac; Department of Hematology, Hôpital du Bocage, Dijon; Department of Hematology, Centre Henri Becquerel, Rouen; Department of Hematology, Hôpital Saint-Antoine, Paris; Department of Hematology, Hôpital Edouard Herriot, Lyon; Department of Hematology, Hôpital André Mignot, Versailles; and Department of Hematology, Centre Hospitalier Universitaire (CHU) Hotel-Dieu, Nantes, France.
Acute myeloid leukemias (AMLs) carrying inv(16)/t(16;16) chromosomal abnormalities are associated with a good prognosis. However, studies of this AML subtype have been hampered by the few number of patients reported, frequently collectively considered with those with AML carrying the t(8;21) translocation. We performed a retrospective study in 110 patients with inv(16)/t(16;16) AML (median age, 34 years) prospectively enrolled in 6 trials conducted in France between 1987 and 1998, with the aim to investigate prognostic factors for complete remission (CR) achievement and outcome of CR patients in this AML subtype. CR rate was 93%. Bad-prognosis factors for CR achievement were higher white blood cell count (WBC) and lower platelet count (optimal cutpoints at 120 and 30 x 109/L, respectively). At 3 years, estimated overall survival, disease-free survival (DFS), and cumulative incidence of relapse were 58%, 48%, and 42%, respectively. In multivariate analysis, (1) advanced age (optimal cutpoint, 35 years) was the only factor for shorter DFS and (2) advanced age and low platelet count were the 2 factors for shorter survival of CR patients. Outcome of CR patients (1) was not influenced by WBC and cytogenetic findings and (2) was similar among patients allocated to receive allogeneic transplantation, high-dose, or intermediate-dose cytarabine. Interestingly, advanced age was associated with a trend for more frequent additional chromosome abnormalities and predictive of higher cumulative incidence of relapse rather than death in first CR. These results markedly contrast with those reported in patients with t(8;21) AML in whom WBC, and not age, was the main high-risk factor for relapse, DFS, and survival.
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