Submitted August 13, 2007
Accepted November 28, 2007
Multilineage dysplasia according to the World Health Organisation (WHO) classification in acute myeloid leukemia (AML) has no correlation with age and no independent prognostic relevance as analysed in 1766 patients
Hannes Wandt*, Ulrike Schakel, Frank Kroschinsky, Gabriele Prange-Krex, Brigitte Mohr, Christian Thiede, Ulrich Pascheberg, Silke Soucek, Markus Schaich, and Gerhard Ehninger
Medizinische Klinik 5, Hamatologie/Onkologie, Klinikum Nurnberg, Nurnberg, Germany
Medizinische Klinik u. Poliklinik I, Universitatsklinikum Carl Gustav Carus der Technischen Universitat, Dresden, Germany
Zytogenetisches Labor, Dr. Eberghard u. Partner, Dortmund, Germany
* Corresponding author; email: wandt{at}klinikum-nuernberg.de.
The German Study Initiative Leukemia (DSIL) registered between February 1996 and December 2004 1766 consecutive patients for the AML 96 study, all of whom were diagnosed by central cytomorphology according to the French-American-British (FAB) and the new WHO classification. We focused our analysis on the prognostic impact of multilineage dysplasia (MLD) as a new parameter of the WHO classification for AML. We could not confirm the WHO statement that MLD occurs most frequently in older individuals but we confirmed that MLD is often associated with an unfavourable cytogenetic profile (p <0.001). In 1332 individuals receiving intensive AML therapy presence of MLD was negatively correlated with complete remission (p=0.001) in univariate, but not in multivariate analysis. Multivariate analysis of either event-free or overall survival again failed to show an independent prognostic significance of MLD beside age, cytogenetics and in part NPM1/FLT3-ITD mutations. Our data support a reassessment of the WHO classification in the light of a more biologic understanding of AML. This study is registered at www.ClinicalTrials.gov as #NCT00180115.
