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. 2013 Sep;13 Suppl 2(0 2):S276-81.
doi: 10.1016/j.clml.2013.05.020. Epub 2013 Aug 19.

Biological and clinical features of trisomy 21 in adult patients with acute myeloid leukemia

Paolo Strati  1 , Naval Daver, Farhad Ravandi, Naveen Pemmaraju, Sherry Pierce, Guillermo Garcia-Manero, Aziz Nazha, Tapan Kadia, Elias Jabbour, Gautam Borthakur, Stefan Faderl, Alfonso Quintas-Cardama, Hagop Kantarjian, Jorge Cortes
Affiliations

Biological and clinical features of trisomy 21 in adult patients with acute myeloid leukemia

Paolo Strati et al. Clin Lymphoma Myeloma Leuk. 2013 Sep.

Abstract

Introduction: Trisomy 21 is frequently noted in patients with AML. In adults, +21 has traditionally been considered an intermediate-risk cytogenetic aberration.

Patients and methods: We analyzed 90 patients with newly diagnosed AML harboring +21. Four cytogenetic subgroups were defined based on associated cytogenetic abnormalities: +21 alone, +21 with favorable, +21 with intermediate, and +21 with unfavorable cytogenetics.

Results: Fifty-four percent of patients with +21 AML achieved a complete remission (CR) or CR with incomplete platelet recovery (CRp) after induction therapy with a trend toward improved CR/CRp rates in patients with +21 alone/+21 with favorable cytogenetics compared with patients with +21 with intermediate/+21 with unfavorable cytogenetics (76% vs. 50%; P = .057). Time to progression (TTP) was 12 months (range, 5-19) and overall survival (OS) was 9 months (range, 7-11) for the entire group. TTP was longer for patients with +21 alone (not reached) or with +21 with favorable cytogenetics (101 months) compared with those with +21 with intermediate cytogenetics (2 months) or +21 with unfavorable cytogenetics (11 months) (P = .02). Similarly, OS was improved in patients with +21 with favorable cytogenetics (not reached) or +21 alone (107 months), compared with +21 with unfavorable cytogenetics (9 months) or +21 with intermediate cytogenetics (8 months) (P < .001). The differences in TTP and OS were maintained on multivariate analysis (P = .04 and P = .001; respectively).

Conclusion: Isolated +21 hitherto classified as intermediate-risk cytogenetics might actually behave as a favorable-risk cytogenetics in adult AML patients.

Keywords: AML; Cytogenetic; Down syndrome; Prognosis; trisomy 21.

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Conflict of interest statement

All authors have no conflict of interests

Figures

Figure 1
Figure 1
(A) Median time to progression (TTP) for the 49 patients that achieved complete remission after induction therapy (B) Median TTP for the 49 patients that achieved complete remission according to cytogenetic subgroup (C) Median TTP for the 49 patients that achieved complete remission according to cytogenetic subgroup, after multivariate COX regression
Figure 2
Figure 2
(A) Median overall survival (OS) for all patients (B) Median OS for all patients according to cytogenetic subgroup (C) Median OS for all patients according to cytogenetic subgroup, after multivariate COX regression analysis
See this image and copyright information in PMC

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