title: Outcomes of 1st Remission Induction Chemotherapy in Acute Myeloid Leukemia Cytogenetic Risk Groups
abstract: Background: Diagnostic karyotyping analysis is routinely used in acute myeloid leukemia (AML) clinics.
  Categorization of patients into risk stratified groups (favorable, intermediate and adverse) according to cytogenetic
  findings can serve as a valuable independent prognostic factor. Method and Material: A retrospective descriptive
  study was conducted based on the patient records of newly diagnosed non-M3 AML young adult cases undergoing
  standard 3+7 i.e, Daunorubicin and Ara-C (DA) as remission induction chemotherapy. Diagnostic cytogenetic analysis
  reports were analyzed to classify the patients into risk stratified groups according to South West Oncology Group
  criteria and prognostic significance was measured with reference to achievement of haematological remission after 1st
  induction chemotherapy. Results: A normal karyotype was commonly expressed, found in 47.2% of patients, while 65%
  (n=39) appeared to have intermediate risk cytogenetics, and 13.3% (n=8) adverse or unclassified findings. Favourable
  cytogenetics was least frequent in the patient cohort, accounting for only 8.3 % (n=5).The impact of cytogenetic risk
  groups on achievement of haematological remission was evaluated by applying Pearson Chi-square, and was found
  to be non-significant (df=12, p=0.256) but when the outcomes of favourable risk groups with intermediate, adverse
  and unclassified findings compared, results were highly significant (df=6, p=0.000) for each comparison. In patients
  of the favourable cytogenetic risk group, HR?? was reported in 40% (n=2/5), as compared to 62.2% (n=23/37) in the
  intermediate cytogenetic risk group, 57.1% (n=4/7) in the adverse cytogenetic risk group and 28.6% (n=2/7) in hte
  unclassified cytogenetic risk group. Conclusion: Cytogenetic risk stratification for AML cases following criteria provided
  by international guidelines did not produce conclusive results in our Pakistani patients. However, we cannot preclude
  an importance as the literature clearly supports the use of pretreatment karyotyping analysis as a significant predictive
  marker for clinical outcomes. The apparent differences between Pakistani and Western studies indicate an urgent need
  to develop risk stratification guidelines according to the specific cytogenetic makeup of South Asian populations.
authors.affiliation: National Institute of Blood Disease and Bone Marrow Transplantation, |Department of Pharmacology, Faculty of Pharmacy,University of Karachi, Pakistan. Email: aarahila18@gmail.com
authors.forename: Samreen
authors.initials: S
authors.lastname: Zehra
authors.forename: Rahela
authors.initials: R
authors.lastname: Najam
authors.forename: Tasneem
authors.initials: T
authors.lastname: Farzana
authors.forename: Tahir
authors.initials: T
authors.lastname: Shamsi
keywords: AML; haematological remission; remission induction chemotherapy; cytogenetics