title: Persistence of cytogenetic abnormalities at complete remission after induction in patients with acute myeloid leukemia: prognostic significance and the potential role of allogeneic stem-cell transplantation.
abstract: OBJECTIVE
  To determine the prognostic impact of persistent cytogenetic abnormalities at complete remission (CR) on relapse-free survival (RFS) and overall survival (OS) in patients with acute myeloid leukemia (AML) and to examine the potential role of allogeneic stem-cell transplantation (SCT) in this setting.
  
  
  METHODS
  Data from 254 adult patients with AML (excluding acute promyelocytic leukemia) who achieved CR after induction chemotherapy on various first-line protocols were examined.
  
  
  RESULTS
  Median follow-up for surviving patients was 43 months. Patients with cytogenetic abnormalities at CR (n = 71) had significantly shorter RFS (P = .001) and OS (P < .001) compared with patients with normal cytogenetics at CR (n = 183); 3-year RFS was 15% and 45%, and 3-year OS was 15% and 56%, respectively. Among the patients with persistent cytogenetic abnormalities at CR, those who underwent SCT in first CR (CR1; n = 15) had better RFS and OS compared to those without SCT (n = 56; P = .04 and .06, respectively). In multivariate analysis, persistent cytogenetic abnormalities at CR was an independent predictor for RFS (P < .001) and OS (P = .001), but among patients with persistent cytogenetic abnormalities at CR, no significant differences in OS (P = .25) was observed between those who did or did not receive SCT with a trend favoring SCT for RFS (P = .08).
  
  
  CONCLUSIONS
  Persistent cytogenetically abnormal cells at CR predict a significantly shorter RFS and OS. SCT in CR1 may improve the clinical outcome of patients lacking cytogenetic remission after induction although this depends on patient selection.
authors.affiliation: University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
authors.forename: Yiming
authors.initials: Y
authors.lastname: Chen
authors.forename: Jorge
authors.initials: J
authors.lastname: Cortes
authors.forename: Zeev
authors.initials: Z
authors.lastname: Estrov
authors.forename: Stefan
authors.initials: S
authors.lastname: Faderl
authors.forename: Wei
authors.initials: W
authors.lastname: Qiao
authors.forename: Lynne
authors.initials: L
authors.lastname: Abruzzo
authors.forename: Guillermo
authors.initials: G
authors.lastname: Garcia-Manero
authors.forename: Sherry
authors.initials: S
authors.lastname: Pierce
authors.forename: Xuelin
authors.initials: X
authors.lastname: Huang
authors.forename: Partow
authors.initials: P
authors.lastname: Kebriaei
authors.forename: Tapan
authors.initials: T
authors.lastname: Kadia
authors.forename: Marcos
authors.initials: M
authors.lastname: De Lima
authors.forename: Hagop
authors.initials: H
authors.lastname: Kantarjian
authors.forename: Farhad
authors.initials: F
authors.lastname: Ravandi
mesh_terms: 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; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D007621:Karyotyping; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000235:genetics* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D011379:Prognosis; D012074:Remission Induction; D012307:Risk Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult