title: Evaluation of prognostic factors in patients with relapsed AML: Clonal evolution versus residual disease.
abstract: BACKGROUND
  It is widely known that the prognosis of acute myeloid leukemia (AML) depends on chromosomal abnormalities. The majority of AML patients relapse and experience a dismal disease course despite initial remission.
  
  
  METHODS
  We reviewed the medical records and laboratory findings of 55 AML patients who had relapsed between 2004 and 2013 and who had been treated at the Division of Hematology of the Pusan National University Hospital.
  
  
  RESULTS
  The event-free survival (EFS) was related to prognostic karyotype classification at the time of diagnosis and relapse (unfavorable vs. favorable or intermediate karyotypes at diagnosis, 8.2 vs. 11.9 mo,P=0.003; unfavorable vs. favorable or intermediate karyotypes at relapse, 8.2 vs. 11.9 mo,P=0.009). The overall survival (OS) was significantly correlated with karyotype classification only at diagnosis (unfavorable vs. favorable or intermediate vs. karyotypes at diagnosis, 8.5 vs. 21.8 mo,P=0.001; unfavorable vs. favorable or intermediate karyotypes at relapse, 8.5 vs. 21.2 mo,P=0.136). A change in karyotype between diagnosis and relapse, which is regarded as a factor of resistance against treatment, was not a significant prognostic factor for OS, EFS, and post-relapse survival (PRS). A Cox proportional hazards model showed that the combined use of fludarabine, cytosine arabinoside, and granulocyte colony-stimulating factor (FLAG) as a salvage regimen, was a significant prognostic factor for OS (hazard ratio=0.399,P=0.010) and the PRS (hazard ratio=0.447,P=0.031).
  
  
  CONCLUSIONS
  The karyotype classification at diagnosis predicts survival including PRS in relapsed AML patients as well as in treatment-naïve patients. We suggest that presently, administration of salvage FLAG could be a better treatment option.
authors.affiliation: Department of Hematology-Oncology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Korea.
authors.forename: Hyojeong
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Hematology-Oncology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Korea.
authors.forename: Young Mi
authors.initials: YM
authors.lastname: Seol
authors.affiliation: Department of Hematology-Oncology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Korea.
authors.forename: Moo-Kon
authors.initials: MK
authors.lastname: Song
authors.affiliation: Department of Hematology-Oncology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Korea.
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Choi
authors.affiliation: Department of Hematology-Oncology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Korea.
authors.forename: Ho-Jin
authors.initials: HJ
authors.lastname: Shin
authors.affiliation: Department of Laboratory Medicine, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Korea.
authors.forename: Sang Hyuk
authors.initials: SH
authors.lastname: Park
authors.affiliation: Department of Laboratory Medicine, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Korea.
authors.forename: Eun Yup
authors.initials: EY
authors.lastname: Lee
authors.affiliation: Department of Hematology-Oncology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Korea.
authors.forename: Joo-Seop
authors.initials: JS
authors.lastname: Chung
keywords: FLAG regimen; Karyotypic change; Relapsed AML