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Clonal evolution detected with conventional cytogenetic analysis is a potent prognostic factor in adult patients with relapsed AML
Author(s) -
Shimizu Hiroaki,
Yokohama Akihiko,
Ishizaki Takuma,
Hatsumi Nahoko,
Takada Satoru,
Saitoh Takayuki,
Sakura Toru,
Nojima Yoshihisa,
Handa Hiroshi
Publication year - 2018
Publication title -
hematological oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 44
eISSN - 1099-1069
pISSN - 0278-0232
DOI - 10.1002/hon.2393
Subject(s) - medicine , multivariate analysis , myeloid leukemia , oncology , hazard ratio , karyotype , cytogenetics , somatic evolution in cancer , refractory (planetary science) , proportional hazards model , chemotherapy , gastroenterology , biology , cancer , chromosome , confidence interval , genetics , astrobiology , gene
We retrospectively investigated 144 patients with relapsed acute myeloid leukemia (AML) to clarify predisposing factors and the prognostic impact of acquisition of additional cytogenetic abnormalities (ACA) at the first relapse. Additional cytogenetic abnormalities are recognized as clonal evolution at the cytogenetic level. Fifty‐nine patients (41%) acquired ACA at the first relapse. The incidences of ACA acquisition varied depending on cytogenetic abnormalities at initial diagnosis. Multivariate analysis identified t(8;21), complex karyotype, and a duration of fewer than 12 months of complete remission as independent predisposing factors for ACA acquisition. Notably, patients with ACA acquisition showed a significantly lower second complete remission rate compared with those without ACA acquisition (20.0% vs 72.5%, respectively, P < .001). Furthermore, the 3‐year overall survival rates after the first relapse were significantly different between patients with and without ACA acquisition (8.5% vs 36.8%, respectively, P < .001). This prognostic significance was confirmed with multivariate analysis. The hazard ratio of ACA acquisition was similar or higher than reported prognostic factors for relapsed AML patients. These findings suggested that clonal evolution detected with conventional cytogenetic analysis at the first relapse induces severe chemo‐refractory characteristics in AML cells and should be considered as a potent prognostic factor when evaluating accurate prognosis in relapsed AML patients.