Published online 27 May 2008
Haematologica, Vol 93, Issue 7, 1025-1032 doi:10.3324/haematol.11889
Copyright © 2008 by Ferrata Storti Foundation
Alessandro Pulsoni1 ,
Simona Iacobelli2 ,
Massimo Bernardi3 ,
Marco Borgia4 ,
Andrea Camera5 ,
Nicola Cantore6 ,
Francesco Di Raimondo7 ,
Paola Fazi2 ,
Felicetto Ferrara8 ,
Franco Leoni9 ,
Vincenzo Liso10 ,
Marco Mancini1 ,
Filippo Marmont11 ,
Angela Matturro1 ,
Luca Maurillo12 ,
Lorella Melillo13 ,
Giovanna Meloni1 ,
Salvo Mirto14 ,
Giorgina Specchia15 ,
Caterina Giovanna Valentini16 ,
Adriano Venditti17 ,
Giuseppe Leone16 ,
Robin Foà1 ,
Franco Mandelli1 ,
Livio Pagano16
Haematologica, Vol 93, Issue 7, 1025-1032 doi:10.3324/haematol.11889
Copyright © 2008 by Ferrata Storti Foundation
Acute Myeloid Leukemia |
M4 acute myeloid leukemia: the role of eosinophilia and cytogenetics in treatment response and survival. The GIMEMA experience
1 Dept. of Hematology, "La Sapienza" University, Rome
2 GIMEMA Data Center, Rome
3 Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan
4 Division of Hematology, Pescara’Hospital
5 Division of Hematology, "Federico II" University, Naples
6 Hematology, "S.G. Moscati" Hospital, Avellino
7 Division of Hematology, Catania’Hospital
8 Division of Hematology, "Cardarelli" Hospital, Naples
9 Dept. of Hematology, University of Florence, Florence
10 Division of Hematology, Bari’Hospital
11 Dept. of Hematology, Azienda Ospedaliera San Giovanni Battista, Turin
12 Dept. of Hematology, Ospedale S.Eugenio, Rome
13 IRCCS "Casa sollievo della sofferenza", San Giovanni Rotondo (Foggia)
14 Division of Hematology, "V. Cervello" Hospital, Palermo
15 Division of Hematology, Foggia Hospital
16 Division of Hematology, Università Cattolica del Sacro Cuore, Rome
17 Division of Hematology, "Tor Vergata" University, Rome, Italy
Correspondence: Alessandro Pulsoni, MD, Division of Hematology, Dipartimento di Biotecnologie Cellulari ed Ematologia, "La Sapienza" University, via Benevento 6, 00161 Rome, Italy. E-mail:pulsoni{at}bce.uniroma1.it
Background: Myelomonocytic acute myeloid leukemia (M4-AML) is frequently associated with the cytogenetic marker inv(16) and/or the presence of eosinophilia. The aim of this study was to analyze the incidence and prognostic role of these factors in a large series of patients.
Design and Methods: Adult patients with acute myeloid leukemia consecutively enrolled in the GIMEMA trials AML10 and LAM99p were retrospectively analyzed.
Results: Among 1686 patients, 400 cases of M4-AML were identified; of these, 78% had neither eosinophilia nor inv(16), 6% had eosinophilia only, 8% had inv(16) only and 8% had both. Univariate analysis showed that both eosinophilia and inv(16) were correlated with a higher probability of complete remission, lower resistance to chemotherapy and increased overall survival. Multivariate analysis showed that the simultaneous presence of the two factors significantly increased the probabilities of both complete remission and overall survival. The presence of only one of the two factors also increased the probabilities of complete remission and overall survival, but not to a statistically significant extent. The relapse-free survival of the responding patients was not influenced by the two factors.
Conclusions: In a large series of patients with M4-AML we confirmed the favorable role of inv(16), but the weight of this factor among the whole M4 population was of limited relevance. Eosinophilia, which affects a small proportion of cases, also emerged as a favorable prognostic factor. Based on the results of this large case population, overall and relapse-free survival rates of patients with M4-AML are not significantly better than those of patients with non-M4 AML, while the concomitant presence of both inv(16) and eosinophilia was associated with a significantly improved prognosis.
Key words: myelo-monocytic acute leukemia, M4-AML, eosinophilia, inv(16).
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