Therapeutic experience of adult acute myeloid leukemia in a single institution of China and its relationship with chromosome karyotype

One hundred and ninety-six untreated de novo acute myeloid leukemia (AML) patients were treated with homoharringtonine + cytosine arabinoside (HA) based induction therapy composed of three chemotherapeutic drugs (HAD/M, D-daunorubicin-DNR, M-mitozantrone-MTZ) used in our hospital for the past 12 years. The patient population was relatively young (median age 37, oldest patient 67), and patients were excluded if they had prior MDS or prior chemotherapy or radiotherapy. Complete remission (CR) rate, disease free survival (DFS) and overall survival (OS) of the patients were calculated. One hundred and fifty-three patients who had karyotype results were divided into four groups according to Southwestern Oncology Group (SWOG) criteria. Differences of CR rate, DFS and OS of different groups were evaluated. The CR rate of all 196 cases was 153/196 (78.1%), and 95.3% of these were within 1-2 courses. Median DFS of the 153 CR patients was 23.8 (range from 1.0 to 153) months. DFS rates at 3 years and 5 years were 41.1% and 35.9%, respectively. The median OS of 196 patients was 19.3 (0.5-154) months. The probabilities of 3-year and 5-year OS were 31.5% and 29.2%, respectively. CR rate, DFS and OS of the different cytogenetic risk groups were also be analyzed. According to SWOG criteria, patients were classified into favorable, intermediate, adverse and unknown (a group where the meaning of chromosomes are unclear) groups. CR rate, median DFS and OS were 91.9%, 90.8 months and 94.4 months for the favorable group; 86.4%, 22.0 months and 22.8 months for the intermediate group; 59.4%, 9 months and 10.5 months for the adverse group; 76.0%, 22.0 months, 16.1 months for the unknown group, respectively. The differences among the four groups were statistically significant (P=0.001, 0.0033, 0.0001). We conclude that triple-drugs induction regimens based on HA (HAD/M) are highly effective in adult AML in China. Cytogenetics is the important prognostic factor. SWOG karyotype subtyping criteria was appropriate for our patients, the prognosis of the unknown group was similar to that of the intermediate group.