Prognostic implications of in vitro colony studies and clonal chromosomal aberrations in adults with acute leukaemia

A comparison was made between in vitro colony culture parameters and chromosomal abnormalities in 44 adult patients with acute leukaemia, with special reference to prognosis. The presence of clonal chromosomal aberrations in some (AN) or all (AA) metaphases of bone marrow cells was a fairly strong indication of poor prognosis, while the absence of abnormal metaphases (NN) was a favourable prognostic sign. 6 of 7 patients in the NN group entered complete remission (CR), as did 8 of 20 in the AN + AA group and 8 of 17 in the group with random loss of chromosomes (NNA). The median survival time for AN + AA patients was 4 months, while for patients without clonal aberrations (NN + NNA) it was 9 months. Of the cultural parameters studied, colony-stimulating activity (CSA) of peripheral leucocytes had the strongest correlation to prognosis. CSA greater than 1 was related to remission (P less than 0.01) and longer survival (P less than 0.05 at 4 months), while 8 patients with CSA less than or equal to 1 were all dead at 8 months. However, very high CSA values (greater than 20) indicate a poor prognosis. Although both chromosome analysis and CSA were of prognostic value, combining the 2 parameters did not improve the prognostic information, mainly because of covariation of NN and CSA greater than 1.