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Patients with acute myeloid leukemia who have abnormal chromosomes in bone marrow cells at remission are twice as likely to relapse

Patients with acute myeloid leukemia who enter remission with abnormal chromosomes in bone marrow cells are twice as vulnerable to recurrence of disease as patients with normal bone marrow cells at remission, according to an article in the June 15th issue of the Journal of Clinical Oncology.

“For the first time, we have shown in a relatively large group of patients that someone with acute myeloid leukemia who has abnormal chromosomes early during remission will relapse, even if blood counts and other parameters are favorable,” said lead author Guido Marcucci, MD.

Since 1990, physicians have considered patients with acute myeloid leukemia to be in complete remission following treatment if their blood count was normal and their bone marrow contained fewer than 5 percent blast cells. By that definition, 60 to 70 percent of patients achieve complete remission, but only 30 percent to 40 percent of those patients remain in remission long enough to be considered completely cured.

“Achieving complete remission is an important step for a successful treatment,” Marcucci said, “but it does not predict who will do well in the long run and who will relapse. We need additional diagnostic indicators like the presence of abnormal chromosomes.”

Chromosomal abnormalities are seen at diagnosis in about 55 percent of all patients. The presence of chromosomal abnormalities at diagnosis has long proven to be one of the most important prognostic factors for acute myeloid leukemia. Furthermore, the sensitive technology and methods needed for cytogenetic testing, which were formerly found mainly in research laboratories, are now widely available for use in clinical tests.

The current, retrospective study examined the outcomes of 118 patients who had received cytogenetic testing at the time of diagnosis and at the first day of complete remission. Of the total, 103 patients had abnormal chromosomes at diagnosis and normal chromosomes at complete remission. These patients were compared with 15 others who had abnormal chromosomes at both diagnosis and at complete remission.

The results showed that patients with abnormal chromosomes at remission had a significantly shorter survival with twice the risk for relapse and death.

Based on their findings, the researchers concluded that converting from abnormal chromosomes to normal chromosomes at remission is an import predictor of long-term outcome in acute myeloid leukemia and thus cytogenetic testing should become routine as a criterion for remission. Marcucci said, “These findings indicate that the old definition of remission isn’t good enough. We need to include cytogenetic complete remission as a criterion for complete remission in acute myeloid leukemia.”



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