title: [Clinical and biological prognostic factors in relapsed acute myeloid leukemia patients].
abstract: OBJECTIVE
  Acute myeloid leukemia (AML) is the most frequent type of acute leukemia in adults. Despite recent advances in the characterization of pathogenesis of AML, the cure rates are under 40%, being leukemia relapse the most common cause of treatment failure. Leukaemia relapse occurs due to clonal evolution or clonal escape. In this study, we aimed to analyze the clinical and biological factors influencing outcomes in patients with AML relapse.
  
  
  METHODS
  We included a total of 75 AML patients who experienced leukaemia relapse after achieving complete remission. We performed complete immunophenotyping and conventional karyotyping in bone marrow aspirates obtained at diagnosis and at leukemia relapse.
  
  
  RESULTS
  Overall survival (OS) of the series was 3.7%±2.3, leukaemia progression being the most common cause of death. Patients relapsing before 12 months and those with adverse cytogenetic-molecular risk had statistically significant worse outcomes. A percentage of 52.5 of patients showed phenotypic changes and 50% cytogenetic changes at relapse. We did not find significant clinical factors predicting clonal evolution. The presence of clonal evolution at relapse did not have a significant impact on outcome.
  
  
  CONCLUSIONS
  Patients with relapsed AML have a dismal prognosis, especially those with early relapse and adverse cytogenetic-molecular risk. Clonal evolution with phenotypic and cytogenetic changes occurred in half of the patients without predictive clinical factors or impact on outcome.
authors.affiliation: Servicio de Hematología y Hemoterapia, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, España. Electronic address: myebener@gmail.com.
authors.forename: Manuel
authors.initials: M
authors.lastname: Yébenes-Ramírez
authors.affiliation: Servicio de Hematología y Hemoterapia, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, España.
authors.forename: Josefina
authors.initials: J
authors.lastname: Serrano
authors.affiliation: Servicio de Hematología y Hemoterapia, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, España.
authors.forename: Carmen
authors.initials: C
authors.lastname: Martínez-Losada
authors.affiliation: Servicio de Hematología y Hemoterapia, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, España.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Sánchez-García
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D060965:Clonal Evolution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis* / Q000235:genetics / Q000276:immunology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
keywords: Acute myeloid leukemia; Citometría de flujo; Enfermedad mínima residual; Flow cytometry; Leucemia aguda mieloblástica; Minimal residual disease; Recaída; Relapse