title: A white blood cell index as the main prognostic factor in t(8;21) acute myeloid leukemia (AML): a survey of 161 cases from the French AML Intergroup.
abstract: While the t(8;21) translocation is one of the most recurrent chromosomal abnormalities in acute myeloid leukemia, prognostic studies have been hampered by the relatively few number of patients reported. We thus performed a large retrospective study in 161 adults and children with t(8;21) acute myeloid leukemia, all prospectively enrolled in 6 different trials conducted in France between 1987 and 1998 (median follow-up 4.9 years). Prognostic studies were performed in the 154 patients who achieved a complete remission. Individual data were registered, including sex, age, blood and marrow counts, extramedullary disease, and cytogenetics. The value of allogeneic stem cell transplantation versus chemotherapy as postremission therapy was evaluated according to the intent-to-treat principle. Estimated 5-year disease-free survival (DFS) and overall survival were 52% and 59%, respectively. Outcome was not significantly better in patients from the stem cell transplantation group (estimated 5-year DFS and survival, 56% vs 52% and 67% vs 57%; P =.55 and.64, respectively). White blood cell count (WBC) was the only identified prognostic factor. To further take into account the spontaneous differentiation potential of the leukemic clone, a WBC index was derived as the product of WBC by the ratio of marrow blast. This WBC index was a more powerful factor than the original WBC, allowing us to distinguish 3 subgroups of patients with different outcomes (low index, < 2.5; intermediate index, 2.5-20; high index, 20 or more). In multivariate analysis, the WBC index was the only prognostic factor for DFS (P =.003), complete remission duration (P =.002), and overall survival (P =.04).
authors: Department of Hematology, Hôpital Saint-Louis, Paris, France.
authors: Stéphanie
authors: S
authors: Nguyen
authors: Thierry
authors: T
authors: Leblanc
authors: Pierre
authors: P
authors: Fenaux
authors: Francis
authors: F
authors: Witz
authors: Didier
authors: D
authors: Blaise
authors: Arnaud
authors: A
authors: Pigneux
authors: Xavier
authors: X
authors: Thomas
authors: Françoise
authors: F
authors: Rigal-Huguet
authors: Bruno
authors: B
authors: Lioure
authors: Anne
authors: A
authors: Auvrignon
authors: Denis
authors: D
authors: Fière
authors: Josy
authors: J
authors: Reiffers
authors: Sylvie
authors: S
authors: Castaigne
authors: Guy
authors: G
authors: Leverger
authors: Jean-Luc
authors: JL
authors: Harousseau
authors: Gérard
authors: G
authors: Socié
authors: Hervé
authors: H
authors: Dombret
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002454:Cell Differentiation; D002648:Child; D002675:Child, Preschool; D002891:Chromosomes, Human, Pair 21; D002898:Chromosomes, Human, Pair 8; D020732:Cytogenetic Analysis; D003710:Demography; D018572:Disease-Free Survival; D005260:Female; D005602:France; D018380:Hematopoietic Stem Cell Transplantation; D006412:Hematopoietic Stem Cells / Q000166:cytology; D006801:Humans; D007951:Leukemia, Myeloid / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality / Q000628:therapy; D007958:Leukocyte Count / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D014178:Translocation, Genetic