A stage classification for prognosis in adult acute myelogenous leukaemia based upon patients' age, bone marrow karyotype and clinical features

Abstract

In 71 adult acute myelogenous leukemia (AML) cases, the relationship between well-known prognostic features and complete remission (CR) rate and survival was studied. These features were: bone marrow karyotype classified NN, AN, AA; patients'' age; clinical negative prognostic features (NPF): previous history of preleukemia, septicemia or pneumonia, hyperleukocytosis, associated pathology (diabetes, obesity, renal insufficiency, etc.) Age 59 yr was found to be a frontier between 2 homogenous groups having quite different prognosis. The NN/AN/AA classification had good prognostic value (CR rate and survival) in patients under 59 yr, but not in older patients. In those patients over 59, a significant difference in CR rate and survival appeared between cases with NPF and those without. For each feature having an established relationship to survival, a panel of prognostic points was determined as follows: age over 59 (1 point), AA karyotype in patients under 59 (2 points), NPF in patients over 59 (1 point). Using this stage classification, it was possible to classify every case into 1 of 3 groups (i.e., 0 points, 1 point, 2 points). The life-table analysis of these 3 groups showed significant differences. The median survival times were 18.5 mo., 5.2 mo. and 1.3 mo., for the 0-point group (26 cases), the 1-point group (19 cases) and the 2-point group (26 cases), respectively.