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Prepublished online as a Blood First Edition Paper on June 28, 2002; DOI 10.1182/blood-2002-02-0532. This Article Full Text (PDF) All Versions of this Article: 2002-02-0532v1 101/1/64    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Kern, W. Articles by Hiddemann, W. Search for Related Content PubMed PubMed Citation Articles by Kern, W. Articles by Hiddemann, W. Social Bookmarking                   What's this? Submitted February 21, 2002 Accepted June 19, 2002 Early blast clearance by remission induction therapy is a major independent prognostic factor for both achievement of complete remission and long-term outcome in acute myeloid leukemia: data from the German AML Cooperative Group 1992 Trial Wolfgang Kern*, Torsten Haferlach, Claudia Schoch, Helmut Loeffler, Winfried Gassmann, Achim Heinecke, Maria Christina Sauerland, Wolfgang Berdel, Thomas Buechner, and Wolfgang Hiddemann University Hospital Grosshadern, Dept. of Internal Medicine III, Ludwig-Maximilians-University, Muenchen, Germany Dept. of Internal Medicine III, St. Marien-Krankenhaus, Siegen, Germany Dept. of Biostatistics, Westfaelische Wilhelms-University, Muenster, Germany Dept. of Internal Medicine A, Westfaelische Wilhelms-University, Muenster, Germany * Corresponding author; email: wolfgang.kern{at}med3.med.uni-muenchen.de. The risk assessment in patients with acute myeloid leukemia (AML) using mainly pretreatment characteristics may be further improved by incorporating a parameter of early response to therapy. Therefore, in the 1992 trial of the German AML Cooperative Group the amount of residual leukemic blasts in the bone marrow was assessed one week after the end of the first induction course (d16 blasts). The prognostic significance of d16 blasts was analyzed in univariate and multivariate analyses. Four-hundred-and-fourty-nine patients, 16-76 (median 53) years of age, with de novo AML (excluding acute promyelocytic leukemia) entered the trial and were evaluable. Treatment included the TAD/HAM double induction regimen, one course of TAD consolidation therapy, and randomly either three years of monthly myelosuppressive maintenance therapy or S-HAM as a second consolidation course. Cytogenetics were classified as favorable, intermediate, unfavorable and not available in 10.0%, 48.3%, 13.1%, and 28.5%, respectively. The d16 blasts ranged from 0% to 100% (median, 5%, mean±SD, 18.6±28.5%). The complete remission (CR) rate was 72.6%, 17.6% had persistent leukemia (PL), and 9.8% succumbed to hypoplastic death (cases with early death before day 16 were excluded). The median overall survival (OS), event-free survival (EFS), and relapse-free survival (RFS) were 18, 9, and 15 months with 28.4%, 21.6%, and 30.1% at 5 years, respectively. The d16 blasts as a continuous variable were related to CR rate (p<0.0001), PL rate (p<0.0001), OS (p<0.0001), EFS (p<0.0001), and RFS (p=0.0049). The d16 blasts were analyzed multivariately in combination with other previously identified independent prognostic factors for the same group of patients (cytogenetics, age, LDH). Parameters associated with outcome in order of their significance were for the CR rate d16 blasts (p<0.0001), age (p=0.0036), and LDH (p=0.0072); for OS unfavorable cytogenetics (p<0.0001), d16 blasts (p<0.0001), age (p<0.0001), and LDH (p=0.0040); for EFS unfavorable cytogenetics (p<0.0001), LDH (p<0.0001), d16 blasts (p<0.0001), and age (p=0.0061); and for RFS unfavorable cytogenetics (p<0.0001), LDH (p<0.0001), and d16 blasts (p=0.0359), respectively. Thus, the prognostic significance of d16 blasts is independent of pretherapeutic prognostic parameters and predicts the outcome even in patients achieving a CR. These data suggest that the incorporation of d16 blasts into prognostic stratification models may improve the risk-assessment of patients with AML and may be used to guide therapy. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: F. Schneider, E. Hoster, M. Unterhalt, S. Schneider, A. Dufour, T. 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