Prognostic Parameters of Acute Myeloid Leukaemia at Presentation

Abstract

Introduction: The treatment response and outcome in acute myeloid leukaemia (AML) is heterogeneous.

Aim: To analyze the prognostic parameters of AML at presentation.

Methods: The total sample of 44 AML patients was analyzed on the basis of age <55 and ≥55 years, sex, WBC count <50x10/⁹/l and ≥50x10/⁹/l, the Hb concentration <100 g/l and ≥100 g/l, PLT count <100x10/⁹/l and ≥100x10/⁹/l, Karnofsky score <60% and >60%, cytogenetics, CD56 expression, morphological type and types of treatment (standard and reduced induction chemotherapy, high-dose chemotherapy/stem cell transplantation - autologous and HLA matched, related, allogeneic, together and separately).

Results: The age <55 years, Karnofsky score >60% and standard induction chemotherapy statistically correlated with the higher complete remission (CR) rates, longer relapse free survival (RFS), lower relapse rate (RR), and longer overall survival (OS) (p<0.01). The difference in terms of CR and RR between the sexes were not statistically significant (p<0.05), however women had statistically lower OS comparing to men (9.71±4.54 months vs. 38.03±9.17 months) (p<0.01). WBC count ≥ 50x10/⁹/l and the Hb concentration <100 g/l statistically correlated with shorter OS (p<0.05), while the WBC count ≥50x10/⁹/l statistically correlated with shorter RFS (p<0.05). The PLT count <100x10/⁹/l and ≥100x10/⁹/l was not found as prognostically significant for CR, RR, RFS, and OS (p<0.05). In comparison to the standard induction chemotherapy, both types of high dose chemotherapy/stem cell transplantation (HDT/SCT) (10/22), together and separately, resulted in longer RFS, lower RR, and longer OS (p<0.05). The frequency of cytogenetic risk was intermediate 81.6%, unfavorable 13.2%, and favorable 5.3%, respectively. CD56 + expression statistically correlated with the lower PLT count, higher RR, shorter RFS, and shorter OS (p<0.05). Statistical analysis of the cytogenetic risk and morphological types of AML were not possible due to the small number of patients in stratified groups.

Conclusions: Female sex, the WBC count >50x10/⁹/l, the concentration of Hb <100 g/l, and CD56 + expression, at presentation of AML, should be considered as parameters of adverse risk, especially in latter decisions considering post-remission treatment with HDT/SCT.

Keywords: acute myeloid leukaemia; prognosis; prognostic parameter.

Figure 1

Correlation of age and overall survival in AMLpatients

Figrue 2

Relapse free survival compared to the WBC count

Figure 3

Overal survival compared to the Kornofsky score

Figure 4

Overal survival compared to the type of treatment