Clonal evolution detected with conventional cytogenetic analysis is a potent prognostic factor in adult patients with relapsed AML.
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.
['Shimizu|Hiroaki|H|http://orcid.org/0000-0001-7484-7405', 'Yokohama|Akihiko|A|', 'Ishizaki|Takuma|T|', 'Hatsumi|Nahoko|N|', 'Takada|Satoru|S|', 'Saitoh|Takayuki|T|', 'Sakura|Toru|T|', 'Nojima|Yoshihisa|Y|', 'Handa|Hiroshi|H|']
D000293:Adolescent D000328:Adult D000368:Aged D060965:Clonal Evolution D020732:Cytogenetic Analysis D005260:Female D006801:Humans D015470:Leukemia, Myeloid, Acute D008297:Male D008875:Middle Aged D011379:Prognosis D012189:Retrospective Studies D016019:Survival Analysis D055815:Young Adult
clonal evolution relapse acute myeloid leukemia cytogenetic abnormality t(8 21)