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Morphological classification, response to therapy, and survival in 263
adult patients with acute nonlymphoblastic leukemia
R Mertelsmann, H Tzvi Thaler, L To, TS Gee, S McKenzie, P Schauer, A Friedman, Z Arlin, C Cirrincione and B Clarkson
Bone marrow smears of 263 protocol patients with acute nonlymphoblastic
leukemia (ANLL) and related disorders treated between 1970 and 1978 at
MSKCC were reviewed blindly by two pairs of hematomorphologists and
classified according to the FAB system. It was found necessary to add one
category (MO) for acute undifferentiated leukemia and to define more
precise quantitative criteria for the categories M1-M6 based on bone marrow
differential counts. Using this modified FAB classification, agreement
between the two observer groups based on morphology alone was 69%.
Cytochemical stains were essential in establishing the diagnosis in 9%, led
to a change of diagnosis by one observer team in 14%, and helped to confirm
the diagnosis in 32% of cases. Complete remission rates, remission
duration, and survival were not significantly different among diagnostic
categories. Myelodysplastic syndromes (MDS: M6, RAEB, CMML; CR rate 48%)
and ANLL without differentiation (M0, M1, M5a; CR rate 50%) appeared to do
less well than ANLL with partial differentiation (M2, M3, M4, M5b; CR rate
59%) on all three protocols studied. Auer rods were present in 53% of all
cases with 63% in the myeloid categories (M1-M4). Auer rods were found to
be the single most important prognostic parameter in this study, with a
complete remission (CR) rate of 68% in the Auer-rod- positive and of 40% in
the Auer-rod-negative group (p < 0.0001). Survival was significantly
longer for patients exhibiting Auer rods (p < 0.0002). Median survival
for the total group was 13.5 mo and median remission duration for
responders was 11.5 mo in the Auer-rod-positive group compared to 6.2 mo
median survival and 9.2 mo median remission duration for the
Auer-rod-negative group.
Volume 56,
Issue 5,
pp. 773-781,
11/01/1980
Copyright © 1980 by The American Society of Hematology
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