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Chronic myelogenous leukemia in blast crisis: retrospective analysis of prognostic factors in 90 patients
M Griesshammer1, B Heinze, A Hellmann
1Department of Clinical Physiology, University of Ulm, Germany.
Insights
Prognostic factors in Philadelphia chromosome-positive chronic myelogenous leukemia blast crisis were identified. Response to therapy and trisomy 8 were key predictors of survival in this aggressive leukemia subtype.
Area of Science:
- Hematology
- Oncology
- Leukemia Research
Background:
- Philadelphia chromosome-positive chronic myelogenous leukemia (Ph+ CML) in blast crisis has a poor prognosis.
- Identifying prognostic factors is crucial for guiding treatment strategies.
Purpose of the Study:
- To identify significant prognostic factors associated with survival in patients with Ph+ CML in blast crisis.
- To evaluate the impact of clinical, laboratory, and cytogenetic data on patient outcomes.
Main Methods:
- Retrospective review of 90 patients diagnosed with Ph+ CML in blast crisis.
- Univariate and multivariate analyses of clinical, laboratory, and cytogenetic data.
- Evaluation of patient response to therapy as a prognostic indicator.
Main Results:
- Median survival was 11 weeks. Significant univariate prognostic factors for shorter survival included thrombocythemia, high leukocyte count, low Karnofsky index, nonlymphoid morphology, clonal evolution, specific cytogenetic abnormalities (double Philadelphia chromosome, trisomy 8), and lack of response to therapy.
- Achieving remission significantly improved median survival (25 weeks vs. 9 weeks).
- Multivariate analysis identified response to therapy and trisomy 8 as independent prognostic factors.
Conclusions:
- Response to therapy and trisomy 8 are significant independent prognostic factors in Ph+ CML blast crisis.
- Prognostic factor determination aids clinicians in planning therapy, particularly novel treatment approaches.
- Despite poor overall survival, these factors can inform clinical decision-making.
Abstract:
Ninety patients with Philadelphia chromosome-positive chronic myelogenous leukemia in blast crisis were reviewed to identify significant prognostic associations. At diagnosis of blast crisis the main clinical, laboratory, and cytogenetic data were recorded and evaluated for prognostic significance. At the time of the analysis 89 patients had died, with a median survival of 11 weeks from diagnosis of blast crisis. Patient characteristics demonstrated in the univariate analysis to have significant association with shorter survival were: thrombocythemia, leukocyte count above 20 x 10(9), Karnofsky index < 50%, nonlymphoid blast cell morphology, cytogenetic clonal evolution, the presence of a double Philadelphia chromosome or trisomy 8, and no response to therapy. In 17 of 59 patients (29%) evaluable for response to therapy a complete or partial remission was achieved. These responders had a significantly longer median survival (25 weeks) as compared with nonresponders (9 weeks). Response to therapy was significantly better in lymphoid blast crisis and in patients without clonal evolution. In a multivariate analysis containing all significant variables of the univariate analysis two parameters retained their prognostic significance: response to therapy and trisomy 8. In spite of the short overall survival in blast crisis, the determination of prognostic factors may be a useful tool for the clinician planning therapy, especially new therapeutic approaches.
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