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Blood, 15 November 2006, Vol. 108, No. 10, pp. 3280-3288.
Prepublished online as a Blood First Edition Paper on July 13, 2006; DOI 10.1182/blood-2006-04-014324.
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Submitted April 26, 2006
Accepted July 6, 2006
Cytogenetics and age are major determinants of outcome in
intensively treated acute myeloid leukemia patients older
than 60 years: results from AMLSG trial AML HD98-B
Stefan Frohling, Richard F Schlenk, Sabine Kayser, Martina Morhardt, Axel Benner, Konstanze Dohner, and Hartmut Dohner*
Dept. of Internal Medicine III, University Hospital of Ulm,Germany; Brigham and Women's Hospital,USA
Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
Central Unit Biostatistics, German Cancer Research Center, Heidelberg, Germany
* Corresponding author; email: hartmut.doehner{at}uniklinik-ulm.de.
To assess the prognostic impact of cytogenetics in elderly acute myeloid leukemia (AML) patients receiving intensive induction and consolidation treatment according to a single protocol specifically designed for patients above age 60, pretreatment samples from 361 patients registered for the AML HD98-B trial of the German-Austrian AML Study Group were analyzed by chromosome banding and fluorescence in situ hybridization, and cytogenetic findings were correlated with outcome. Using a proportional hazards model with backward selection, 3 prognostic subgroups were identified based on the influence of cytogenetic abnormalities on overall survival (OS): low-risk, t(15;17) and inv(16) (25 of 361 patients, 7%); standard-risk, normal karyotype, t(8;21), t(11q23), +8 within a noncomplex karyotype, and +11 within a noncomplex karyotype (208 of 361 patients, 58%); high-risk, all other aberrations (128 of 361 patients, 35%). On multivariate analysis, high-risk cytogenetics (hazard ratio, 2.24) and age above 70 (hazard ratio, 2.34) were independent prognostic factors affecting OS, and stratification according to these parameters demonstrated that a large subgroup of patients (55%), characterized by age 70 or older or high-risk cytogenetics, or both, had very unfavorable treatment results despite intensive chemotherapy. Thus, karyotype and age are major determinants of outcome in elderly AML patients.

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