Cytogenetic remission as an important criterion for treatment efficacy in pediatric acute myeloid leukemia

CLINICAL PRESENTATION, DIAGNOSIS, AND MANAGEMENT OF MYELOID MALIGNANCIES , ,

E.W. Fleischman1, O.I. Sokova1, A.V. Popa2, V.S. Nemirovchenko2, L.N. Konstantinova1, and N.F. Metelkova1

1 Institute of Сarcinogenesis, N.N. Blokhin Russian Cancer Research Center, RAMS, Moscow, Russian Federation

2 Pediatric Oncology and Hematology Institute, N.N. Blokhin Russian Cancer Research Center, RAMS, Moscow, Russian Federation

ABSTRACT

The results of repeated karyotype analyses in the disease course in 43 children with de novo acute myeloid leukemia (AML) are presented. Patients with clonal bone marrow chromosome abnormalities at diagnosis were included. The follow-up period lasted from 4 to 79 months (median 23 months). The patient cohort was divided into two groups: the standard-risk group and high-risk group. The first group included 13 children with t(8;21)(q22;q22), inv(16)(p13;q22), and t(16;16)(p13;q22). The rest of the patients (30 cases) formed the second group. After assessment of results of bone marrow chromosome analysis at 1–3 months of the treatment, the conclusion was drawn that persistence even single cytogenetically abnormal cell at the start of morphological remission is an unfavorable prognostic sign. It is illustrated by comparison of relapse-free survival (RFS) in two groups of patients: with cytogenetic remission at the onset of morphologic remission (group 1) or with no remission (group 2). RFS was 64.1 ± 10.3 % in the first group. In the second group, one patient is at 20th month of the first CCR and four remaining patients relapsed at 3–20th months (p = 0.018). Another conclusion can be made from our data. Persistence in bone marrow cytogenetically abnormal cells at the beginning of morphological remission can be observed in patients with favorable chromosome markers and patients from other prognostic groups. This finding was prognostically unfavorable regardless of risk-group. Thus, persistence of cytogenetically abnormal cells in bone marrow at the time of morphological remission achieved is a more sensitive criterion for poor outcome than the baseline karyotype (risk groups). The facts obtained show an importance of cytogenetic analysis performance not only at diagnosis but also at the onset of morphologic remission.

Keywords: pediatric acute myeloid leukemia, chromosome markers, cytogenetic remission.

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