title: Morphologic dysplasia in de novo acute myeloid leukemia (AML) is related to unfavorable cytogenetics but has no independent prognostic relevance under the conditions of intensive induction therapy: results of a multiparameter analysis from the German AML Cooperative Group studies.
abstract: OBJECTIVE
  On the basis of cytomorphology according to the French-American-British (FAB) classification, we evaluated the prognostic impact of dysplastic features and other parameters in de novo acute myeloid leukemia (AML). We also assessed the clinical significance of the recently introduced World Health Organization (WHO) classification for AML, which proposed dysplasia as a new parameter for classification.
  
  
  METHODS
  We analyzed prospectively 614 patients with de novo AML, all of whom were diagnosed by central morphologic analysis and treated within the German AML Cooperative Group (AMLCG)-92 or the AMLCG-acute promyalocytic leukemia study.
  
  
  RESULTS
  Patients with AML M3, M3v, or M4eo demonstrated a better outcome compared with all other FAB subtypes (P <.001); no prognostic difference was observed among other FAB subtypes. The presence or absence of dysplasia failed to demonstrate prognostic relevance. Other prognostic markers, such as age, cytogenetics, presence of Auer rods, and lactate dehydrogenase (LDH) level at diagnosis, all showed significant impact on overall and event-free survival in univariate analyses (P <.001 for all parameters tested). However, in a multivariate analysis, only cytogenetics (unfavorable or favorable), age, and high LDH maintained their prognostic impact. Dysplasia was not found to be an independent prognostic parameter, but the detection of trilineage dysplasia correlated with unfavorable cytogenetics.
  
  
  CONCLUSIONS
  Our results indicate that cytomorphology and classification according to FAB criteria are still necessary for the diagnosis of AML but have no relevance for prognosis in addition to cytogenetics. Our results suggest that the WHO classification should be further developed by using cytogenetics as the main determinant of biology. Dysplastic features, in particular, have no additional impact on predicting prognosis when cytogenetics are taken into account.
authors.affiliation: Department of Medicine III, Ludwig-Maximilians-University, Grosshadern, Munich, Germany. torsten.haferlach@med3.med.uni-muenchen.de
authors.forename: Torsten
authors.initials: T
authors.lastname: Haferlach
authors.forename: Claudia
authors.initials: C
authors.lastname: Schoch
authors.forename: Helmut
authors.initials: H
authors.lastname: Löffler
authors.forename: Winfried
authors.initials: W
authors.lastname: Gassmann
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kern
authors.forename: Susanne
authors.initials: S
authors.lastname: Schnittger
authors.forename: Christa
authors.initials: C
authors.lastname: Fonatsch
authors.forename: Wolf-Dieter
authors.initials: WD
authors.lastname: Ludwig
authors.forename: Christian
authors.initials: C
authors.lastname: Wuchter
authors.forename: Brigitte
authors.initials: B
authors.lastname: Schlegelberger
authors.forename: Peter
authors.initials: P
authors.lastname: Staib
authors.forename: Albrecht
authors.initials: A
authors.lastname: Reichle
authors.forename: Uschi
authors.initials: U
authors.lastname: Kubica
authors.forename: Hartmut
authors.initials: H
authors.lastname: Eimermacher
authors.forename: Leopold
authors.initials: L
authors.lastname: Balleisen
authors.forename: Andreas
authors.initials: A
authors.lastname: Grüneisen
authors.forename: Detlef
authors.initials: D
authors.lastname: Haase
authors.forename: Carlo
authors.initials: C
authors.lastname: Aul
authors.forename: Jochen
authors.initials: J
authors.lastname: Karow
authors.forename: Eva
authors.initials: E
authors.lastname: Lengfelder
authors.forename: Bernhard
authors.initials: B
authors.lastname: Wörmann
authors.forename: Achim
authors.initials: A
authors.lastname: Heinecke
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Sauerland
authors.forename: Thomas
authors.initials: T
authors.lastname: Büchner
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hiddemann
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001853:Bone Marrow / Q000473:pathology; D002869:Chromosome Aberrations; D020732:Cytogenetic Analysis; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D007621:Karyotyping; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D007951:Leukemia, Myeloid / Q000145:classification* / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012074:Remission Induction; D015996:Survival Rate
chemical_list: D007770:L-Lactate Dehydrogenase