Prognostic Factors

A number of patient characteristics have now been identified as prognostic factors in the treatment of AML (Table 35.1). Interpretation of clinical trial results must take into account these different prognostic subtypes. Factors that have consistently been found to predict poor therapeutic outcome with standard CT include old age, high white blood cell (WBC) count at diagnosis, AML arising from an antecedent stem cell disorder (e.g., myelodysplasia), therapy-related leukemia, extramedullary disease, more than one cycle of induction chemotherapy to achieve complete remission (CR), MDR-1 expression by flow cytometry, poor-risk cytogenetics (including abnormalities of chromosomes 3q, 5q, 7, 11q23, or complex karyotype), internal tandem duplications of the FLT3 receptor tyrosine kinase, or the presence of minimal residual disease at completion of consolidation CT (Table 35.2).7-11 Favorable prognostic factors include the lack of the above characteristics. In addition, these include cytogenetic abnormalities, such as the 15; 17 translocation in acute promyelocytic leukemia, or transcriptional repression of the core binding factor complex associated with 8;21 translocation or inversion of chromosome 16.9

In general, patients with secondary or therapy-related AML, myelodysplasia, and residual cytogenetic abnormalities are rarely treated with ASCT. All other subgroups have been considered appropriate for clinical trials.

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