Overall Survival In Different Groups Research Articles

Association of Rebleeding and Delayed Cerebral Ischemia with Long-term Mortality Among 1-year Survivors After Aneurysmal Subarachnoid Hemorrhage.

The potential impact of rebleeding and Delayed Cerebral Ischemia (DCI) on long-term survival in patients with aneurysmal subarachnoid hemorrhage (aSAH) remained unclear. This study aimed to investigate whether DCI and rebleeding increase the risk of long-term all-cause mortality in patients with aSAH who survived the follow-up period of one year. We retrospectively collected data on patients with atraumatic aSAH who were still alive 12 months after aSAH occurrence between December 2013 and June 2019 from the electronic health system. Patients were then classified by the occurrence of rebleeding or DCI during hospitalization. Death records were obtained from an administrative database, the Chinese Household Registration Administration System, until April 20, 2021. Multivariable Cox proportional hazards models were used to compare overall survival in different groups. Sensitivity analysis was performed with propensity-score matching (PSM). A total of 2,607 patients were alive one year after aSAH. The crude annual death rate from any cause among patients who had rebleeding (7.2 per 100 person-years) and patients who had DCI (3.7 per 100 person-years) during hospitalization was higher than that of patients with neither event (2.1 per 100 person-years). Multivariate analysis showed that rebleeding is an independent risk factor for long-term mortality (adjusted hazard ratio (aHR), 2.37; 95% confidence interval (CI), 1.47- 3.81). DCI was an independent prognostic factor of poorer overall survival (aHR, 2.09; 95% CI, 1.54-2.84). Amongst patients alive one year after aSAH, rebleeding and DCI during hospitalization were independently associated with higher rates of long-term mortality.

Clinicopathological analysis of 285 cases of elderly patients with epithelial ovarian cancer.

e17539 Background: Elderly patients with epithelial ovarian cancer often cannot receive standard treatment, and their survival time decreases with age, seriously threatening their lives. Elderly patients with epithelial ovarian cancer tend to have many complications and poor tolerance to surgery and chemotherapy, resulting in poor overall prognosis. Methods: The clinicopathological data of EOC patients aged ≥ 60 years old who were diagnosed and treated in our hospital from January 2013 to January 2018, with completed clinical and pathological data were collected for analysis and followed up through outpatient review, telephone, WeChat, QQ group, etc. to analyze the diagnosis and treatment plan and main prognostic factors. The deadline for follow-up was March 1, 2020. Results: Comparison of recurrence and the overall survival in different groups, the results respectively showed that the difference had statistically significant (χ2 = 255.027, p < 0.001) 、(χ2 = 314.443, p < 0.001). Analysis of the factors affecting the recurrence and death of patients showed that the results of single factor analysis showed age, BMI, Combined with cardiovascular and cerebrovascular diseases, pre-treatment CA125 value, thrombus score, FIGO staging, pathological type, residual lesion size are the influencing factors of recurrence. Further multivariate analysis showed that combined cardiovascular and cerebrovascular diseases, pre-treatment CA125 value, FIGO stage, residual lesion size is an independent factor affecting relapse. The median survival time of relapse-free in the neoadjuvant chemotherapy group was 39.00 (30.67̃44.95) months; the median survival time of relapse-free in the directing surgery group was 36.00 (29.47̃42.53) months, statistical comparison showed no significant difference (χ2 = 2.426, p = 0.119). The total median survival time of the neoadjuvant chemotherapy group was 49.57 months; for the directing surgery group, the total median survival time was 47.07 months, and the statistical comparison showed no significant difference (χ2 = 0.166, p = 0.684). Conclusions: For the epithelial ovarian cancer in elderly patients the results showed that the standard treatment group was better than the non-standard treatment group, chemotherapy-only group, surgery-only group, and untreated group. Comparing with primary tumor debulking surgery (PDS),neoadjuvant chemotherapy-Interval debulking surgery (NACT-IDS) group could improve the intraoperative situation，reduce the amount of intraoperative bleeding, shorten the operation time, reduce the wound healing rate and the incidence of surgical complications, but it had no effect on the tumor removal rate, PFS and OS.

Clinical Efficacy Analysis of the Low-Dose Decitabine in Combination with Cytarabine, All-Trans Retinoic Acid and Granulocyte Colony-Stimulating Factor for Patients with MDS-EB

▪AbstractPurpose:Treatment of patients with myelodysplastic syndromes with excess blasts (MDS-EB) remains a great challenge. In this study, we evaluated the tolerance and efficacy of the combination of low-dose decitabine, cytarabine, all-trans retinoic acid and granulocyte colony-stimulating factor (DLAAG) for MDS-EB patients.Methods:A total of 18 patients with MDS-EB were enrolled in this study and 1 patient who did not follow-up the bone marrow evaluation was excluded from analysis. This study is registered at ClinicalTrials.gov, NCT03356080.The DLAAG regimen consisted of subcutaneous injection of decitabine (0.1-0.2mg/kg, d1-3/w, lasted for 1-3 weeks), cytarabine (6-15mg/m 2,q12h,d1-10), oral all-trans retinoic acid (45mg/m 2/d, d4-6; 15mg/m 2/d, d7-20) and G-CSF (300ug, from d0 until neutrophil count recovery to 20×10 9 cells/L).Results:Patient characteristicsA total of 18 patients (11 males, 7 females) with a median age of 61 years (range 45 to 88 years) were enrolled in our study. The clinical characteristics of the patients were shown in Table 1.Response and survivalThe clinical outcome and overall survival (OS) of patients were summarized in Table2 including 1 could not evaluable after the first protocol. As shown in Table3, after one course of DLAAG, the CR and OR rate was 55.56% and 77.78% respectively. In addition, 3 patients suffered the disease progression (PD) (n=3,16.67%). We found that those who achieved the bone marrow remission after DLAAG had significantly pro-longed OS than others (p=0.0001, Fig.1). The Kaplan-Meier analysis revealed the median overall survival for all patients enrolled was 15 months (Fig.2A), and the relapse-free survival (RFS) for patients achieving CR or CRm was 11 months (Fig.2B).Genetic mutations and response to DLAAGPaired samples (pre- and post-treatment) of the objects were tested for gene mutations which were recurrently mutated in myeloid malignancies, except 1 patient who was failure to perform bone marrow review. 2 patients (11.1%) had no genetic or cytogenetic abnormalities either at baseline or during therapy (they were tested at baseline and d28). Most patients (15 out of 18) had at least one somatic mutation. In this latter group, only 1 patient acquired specific mutation of IDH2 during the therapy (it was tested on d28, data was not shown), while all the other genes were mutated in patients at baseline. Collectively, the most frequently mutated genes at diagnosis were RUNX1 (n=5, 29.4%), ASXL1 (n=4, 23.5%), as well as the overexpression of WT1 (n=4, 23.5%), and the others with an incidence of more than 10% were TET2(n=3,17.6%),TP53 (n=2, 11.8%), EZH2 (n=2, 11.8%), STAG2 (n=2, 11.8%), SF3B1 (n=2, 11.8%) and U2AF1 (n=2, 11.8%).Genes less frequently mutated such as CEBPA,CUX1 et al. were not shown. Remarkably, the proportion of patients with the above gene mutations showing no significant increasing during therapy as compared to baseline, the clones of WT1/TET2/TP53/EZH2/STAG2 can decrease or even disappear(Fig.3A).Moreover, we noted the complete response in patients with ASXL1, TP53 mutations or WT1 overexpression despite the concomitant presence of complex cytogenetic at diagnosis, whereas patients with the EZH2 mutation were less likely to respond (Fig.3B).Subgroup analysisA subgroup analysis based on the 2016 WHO classification revealed an association of EB-I patients with longer OS(P=0.002) (Fig. 4A). On the other hand, based on the IPSS score our study revealed that the lower-risk group patients have better OS (p= 0.0054) (Fig. 4B).In addition to this, we also compared the OS in different groups of age and karyotype, but there were no statistical difference (Fig. 4C-D).Safety and TolerabilityAll patients who received the therapy were eligible for toxicity evaluation. Given the patient-population enrolled and treatment regimen, myelosuppression occurred in all patients (Table 4). The grade 3 to 4 hematological toxicities including neutropenia and thrombocytopenia were common after treatment. Febrile neutropenia occurred in 77.8% of the patients.Conclusion: This study suggested the novel combination of LD-DAC, Ara-C, ATRA and G-CSF might be an optimal introduction therapy for patients with MDS-EB, and this combination warrants further investigation in larger trials. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Low expression of CDHR1 is an independent unfavorable prognostic factor in glioma.

Background: Analysis of the differentially expressed genes between lower grade glioma (LGG) and glioblastoma (GBM) will identify genes involved in a more aggressive phenotype of glioma.Methods: Differentially expressed genes between GBM and LGG were identified using published datasets. Kaplan-Meier estimator was used to determine the overall survival of different groups of glioma patients. The biological functions of CDHR1 in glioma were tested using CCK-8 and trans-well assays.Results: CCDC109B, CD58, CLIC1, EFEMP2, EMP3, LAMC1, LGALS1, PDLIM1 and TNFRSF1A were over-expressed, while, CDHR1 was down-regulated in GBM in The Cancer Genome Atlas (TCGA), Chinese Glioma Genome Atlas (CGGA), GSE4412 and GSE43378 datasets. Compared with normal brain tissues, CDHR1 was down-regulated in glioma tissues. And low expression of CDHR1 was an unfavorable prognostic factor in glioma. Moreover, CDHR1 was lowly expressed in mesenchymal GBM subtype and lower expression of CDHR1 was associated with the worse clinical prognosis of GBM. Furthermore, CDHR1 was down-regulated in astrocytoma LGG subtype and low expression of CDHR1 was a bad prognosis of LGG. CDHR1 expression levels were also associated with IDH mutation. IDH mutant LGG or GBM patients were with higher CDHR1 expression. High expression of CDHR1 was a favorable prognosis in IDH mutant or IDH wild type LGG patients. CHDR1 expression was associated with MGMT methylation and CDHR1 was down-regulated in chemotherapy un-responsive LGG patients. CDHR1 was an independent prognostic factor and negatively associated with EMP3 expression. Glioma patients with low CDHR1 and high EMP3 expression had worse clinical outcomes. At last, we showed that over-expression of CDHR1 could inhibit glioma cell growth and invasion.Conclusion: Low expression of CDHR1 was an independent unfavorable prognostic factor in glioma.

Comprehensive Transcriptomic Analysis Identifies ST8SIA1 as a Survival-Related Sialyltransferase Gene in Breast Cancer.

Hypersialylation caused by the overexpression of sialyltransferases (STs) is a common feature in cancer that is associated with several characteristics of tumorigenesis. Thus, identifying cancer-associated STs is critical for cancer therapy. However, ST screening has been frequently conducted in cell line models. In this study, we conducted a comprehensive analysis of STs in the clinical database and identified the STs related with the survival of breast cancer patients. RNA sequencing (RNA-Seq) data of 496 patients were obtained from The Cancer Genome Atlas Breast Invasive Carcinoma (TCGA-BRCA). Of the eight mapped STs, ST3GAL5, and ST8SIA1 met the acceptable area under the curve (AUC) criteria for overall survival (OS). Using Kaplan–Meier methods, we determined that high expression of ST8SIA1 was associated with poor 10-year OS in all patients, triple-negative breast cancer (TNBC), and non-TNBC patients, and poor disease-free survival (DFS) rates particularly in TNBC. ST8SIA1 also had superior AUC values in terms of OS/DFS. High ST8SIA1 levels showed a higher risk for poor OS in different groups of patients and a higher risk for poor DFS particularly in TNBC. In summary, we conducted a comprehensive analysis of STs from the clinical database and identified ST8SIA1 as a crucial survival-related ST, which might be a potential therapeutic target for breast cancer and TNBC patients.

Prediction of Poor Prognosis of HCC by Early Warning Model for Co-Expression of miRNA and mRNA Based on Bioinformatics Analysis.

Objective:Hepatocellular Carcinoma (HCC) has the highest mortality rate worldwide with the intractability of its extremely complicated pathogenesis and unclear mechanism. The limited survival highlights the need for the further detection of prognosis for HCC. MicroRNAs (miRNAs) and messenger RNAs (mRNAs) have been identified as regulatory factors and target genes in human cancers, while some studies also found post-transcriptional modification plays a crucial role in the occurrence and development of HCC. The present study aimed to elucidate the prognostic significance of miRNA and mRNA models in HCC.Methods:Data were obtained from The Cancer Genome Atlas (TCGA), International Cancer Genome Consortium (ICGC), and Gene Expression Omnibus (GEO) databases. The miRNA and mRNA expressions were tested by the Wilcoxon and used funrich software to predict mRNA that might be related to miRNA. Then we determined the intersection with overlapped mRNA and miRNA Venn diagram, and screened out hub gene by using Degree algorithm in Cytoscape software. The COX models, with TCGA data as the training set and ICGC data as the test set, were constructed. All patients were divided into high-risk and low-risk groups. Data on overall survival of different groups were collected and analyzed by Kaplan-Meier method, and independent risk factors affecting prognosis were assessed by Cox analysis.Results:The miRNA and mRNA polygenic risk model showed a good true positive rate. Kaplan-Meier curve and Cox analysis suggested that the high-risk group was associated with poor prognosis, and the risk score could be used as an independent risk factor for HCC.Conclusion:Tumor risk models constructed in this study could effectively predict the prognosis of patients, which is expected to provide a reference for the prognostic stratification and treatment strategy development of HCC.

Expression of V-domain immunoglobulin suppressor of T cell activation is associated with the advanced stage and presence of lymph node metastasis in ovarian cancer.

V-domain immunoglobulin suppressor of T cell activation (VISTA) is a novel negative immune checkpoint that belongs to the B7 family. VISTA is primarily expressed on hematopoietic cells and inhibits T cell proliferation and cytokine production. The blockade of VISTA has demonstrated promising results in certain murine tumor models. In the present study, an immunohistochemical analysis of VISTA expression on tumor cells, intratumoral immune cells and vascular endothelial cells was performed in a cohort of 65 patients with ovarian cancer (OC). The associations between VISTA expression and different clinicopathological characteristics were evaluated using Fisher's exact test, and the analysis of overall survival in different groups was performed by the construction of Kaplan-Meier curves. The results indicated that high expression of VISTA on tumor cells or ICs was significantly associated with advanced tumor stage and the presence of lymph node metastasis (LNM). However, the percentage of cases with high expression of VISTA on tumor cells (24.6%) was decreased compared with those with high expression on ICs (44.6%). There was no association between VISTA expression and the 5-year overall survival rate, and advanced-stage disease was the only independent predictor of poor prognosis based on multivariate Cox regression analysis. In general, VISTA expression increased with advanced disease stage and LNM, indicating that VISTA expression is involved in the progression of OC. More importantly, these data implicate VISTA as a candidate immunotherapeutic target in OC.

Predictive value of 18F-FDG PET/CT before or after autologous hematopoietic stem cell transplantation for the clinical outcome of patients with non-Hodgkin′s lymphoma

Objective To evaluate the predictive value of 18F-fluorodeoxyglucose (FDG) PET/CT before or after autologous hematopoietic stem cell transplantation (Auto-HSCT) in patients with non-Hodgkin′s lymphoma (NHL). Methods Fifty-eight NHL patients who underwent PET/CT scan before or after Auto-HSCT were retrospectively analyzed. Between June 2007 and May 2016, 40 patients (32 males, 8 females; median age 39 years) underwent 18F-FDG PET/CT pre-transplantation, and 34 patients (23 males, 11 females; median age 34 years) underwent 18F-FDG PET/CT post-transplantation. There were 16 patients underwent both pre- and post-transplantation imaging. PET/CT results were categorized as positive or negative according to the standard response criteria. The predictive value of PET/CT was evaluated with progression-free survival (PFS) and overall survival (OS) using Kaplan-Meier survival analysis and log-rank test. Three-year PFS and OS of different groups were compared with Fisher exact test. Results (1)18F-FDG PET/CT before Auto-HSCT: PFS of patients in PET/CT negative group (n=27) and positive group (n=13) were significantly different (χ2=4.187, P 0.05). (2)18F-FDG PET/CT after Auto-HSCT: PFS and OS of patients in PET/CT negative group (n=18) and positive group (n=16) were significantly different (χ2 values: 15.430, 7.726, both P<0.01). The 3-year PFS and OS of the 2 groups were 8/10 vs 2/12(P=0.005) and 8/10 vs 4/12 (P=0.038), respectively. Conclusion 18F-FDG PET/CT before or after Auto-HSCT could provide prognostic information for NHL patients. Key words: Lymphoma, non-Hodgkin; Hematopoietic stem cell transplantation; Prognosis; Positron-emission tomography; Tomography, X-ray computed; Deoxyglucose

Related or Unrelated Donor Results in Similar Outcomes after Hsct; Single Center Experience in Colombia

INTRODUCTIONASTC is the standard treatment in multiple hematologic diseases; unfortunately most patients do not have a compatible family donor, URD ASCT is an alternative to those patients. There is evidence from developed countries that outcomes may be similar regardless the donor, but there is not enough information from Latin America regarding survival after URD ASCT. We compared survival at 1 and 3 years from patients transplanted using related or unrelated donors in a single center in Colombia.MATERIALS AND METHODSPaired analysis was performed comparing one URD ASCT with one or two RD ASCT with similar characteristic in terms of age, diagnosis (AML, ALL, aplasia, CML, MDS), EBMT risk, year of transplant and conditioning regimen. Chi-square or Fisher exact test was used to compare the groups (p<0.05). The survival curves of Kaplan-Meier and log-rank test (p<0.05) were used to estimate the probabilities of one (OS1) and three (OS3) overall survival in different groups according to EMBT score risk.RESULTS28 URD ASCT were performed between 2011 and 2014, 24 of those (18 matched and 6 missmatched URD ASCT) were paired with 41 RD ASCT. Of those 62% were males, mean age was 33.4 years, 70.8% patients were in early stages, almost 60% had more than 12 months interval between diagnosis and transplant. Most common diagnoses were acute lymphoid leukemia and acute myeloid leukemia. 80% of donors where found through NMDP. No significant differences in sex, age, disease status (early, intermediate, late), time interval from diagnosis to transplantation, and patient-donor sex combination, ranked according to EBMT risk score, were find between the tow groups.Median follow-up was 322 days (range 165-693), for the whole group. There were no significant differences in the OS1 or OS3 between URD o RD ASCT, in different EBMT score groups. Low risk: OS1: URD 86.6% vs RD 75.8%, p = 0.46; OS3: 86.6% vs 68.9%, p = 0.28. High risk OS1 75% vs 63.6%, p=0.92; OS3 75% vs 63.6%, p=0.92.CONCLUSIONSIn this cohort of patients, the type of donor had no influence in the outcome measured in terms of OS. This is the first experience with URD ASCT in Colombia; longer follow up of this cohort is needed to confirm this results, but our findings suggest this transplantation modality is a real alternative to patients in our country in need of a transplant without an HLA identical related donor. DisclosuresNo relevant conflicts of interest to declare.

Serum Kappa/Lambda Ratio, An Independent Prognostic Factor at Diagnosis and Serum Free-Light Chains Level, An Early Indicator of Relapse/Progression In Multiple Myeloma

AbstractAbstract 2954 Background:The serum free light chain (sFLC) analysis has been used for the diagnosis and monitoring of plasma cell dyscrasias and has proved its usefulness in disease treatment response in multiple myeloma (MM). Some studies have evaluated the prognostic value of the sFLC levels expressed as K/L ratio (sFLCR) at diagnosis. In contrast, performing this analysis during patient's follow up and on therapy is still not very well defined yet. Aim:Our first objective was to evaluate the impact of sFLCR, measured at diagnosis in MM patients, on the progression free survival (PFS) and overall survival (OS); the second objective was to assess the importance of sFLC analysis during the follow-up especially for relapse/progression detection comparing to concomitant monoclonal-protein (M-p) traditional serum protein electrophoresis (sPE). Methods:Between years 2002 and 2008, we have analysed 174 MM patients for which a concomitant measurement of sFLC and sPE was done during follow-up. Only 118 patients had the sFLCR analysis performed at diagnosis. The sFLC analysis was performed using the Freelite™ test from the Binding site on a BNIIÒ, Dade BehringÓ, and for sPE, analysis was done using a Paragon CZE 2000Ò, Beckman CoulterÓ. There were 92 (53%) males and 82 (47%) females, median age at diagnosis 57 years (34-72), 120 (69%) were IgG (87K&33L), 52 (30%) IgA (41K&11L) and 2 (1%) IgD (1K&1L). According to the ISS, there were 16 (9%) in stage I, 17 (10%) in stage II and 141 (81%) in stage III. Among 61 (35%) FISH analysis done, 31 (51%) detected a chromosome 13 deletion. Twenty six (15%) patients had renal insufficiency. According to the distribution of the different ratios at diagnosis, we have defined three groups: group1 (n=25): patients with 0.13<sFLCR<3.3 which represents the double of the normal range (0.26-1.65); group2 (n=63): patients with sFLCR>3.3 and group3 (n=30): patients with sFLCR<0.13.We also monitored the behaviour of sFLC and sPE in a way to early detect relapse/progression independently of treatment type. Kaplan Meier and cox regression analysis were performed to study the PFS and OS in different groups, slopes of the increase period corresponding to each measurement were compared using the student t-bilateral test with R statistical software. Results:After a median follow-up of 38 months [3.3-93.7], the 5-years OS for groups 1, 2 and 3 was 75% [56-100], 60% [47-76] and 40% [23-69] respectively; and the 5-years PFS was 69% [49-96], 43% [31-60] and 29% [15-54] respectively. The multivariate analysis studying age, ISS, sex, cytogenetics and sFLCR, showed that both OS and PFS are worslty affected with a more abnormal sFLCR, hazard ratios (HR) in Figure1. After monitoring all patients, we observed 117 (67%) patients with relapse/progression and 57 (33%) patients were still in response to treatment. In 77 (66%) cases, relapse or progression was detected by concomitant increase of both sFLC and the M-p with a significant earlier increase for sFLC (Figure2A). In 17 (15%) patients, the relapse or progression was characterised by the only increase of sFLC without any increase of the M-p (Figure2B). Contrarily, in 5 (4%) patients there was only an increase of the M-p without increasing the sFLC (Figure2D). Finally, in 18 (15%) patients, the relapse or progression was revealed by the increase of M-p faster than the concerned sFLC (Figure2C). When comparing slopes of increasing sFLC to increasing M-p, we found a very high significant difference (p<0.001), thus showing that sFLC have a faster detection of relapse or progression. Conclusion:Our study has showed that abnormal sFLCR at diagnosis affects OS and more strongly the PFS independently of any other concomitant variable. In 81% of patients, sFLC analysis enabled an earlier detection of relapse/progression compared to sPE, this could be very important for early treatment intervention especially for high risk patients. Since there are no uniform recommendations for the use of this analysis during follow-up, we recommend its concomitant use with sPE, waiting for guidelines and we suggest that the sFLCR at diagnosis deserves more focus for its validation as a prognostic factor in MM. [Display omitted] Disclosures:No relevant conflicts of interest to declare.

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.

Results of Acute Myeloid Leukemia Treated with Triple-Drug Regimen Based on HA as Induction Chemotherapy and Its Relationship with Karyotype.

243 untreated de novo acute myeloid leukemia (AML) patients were treated with (homoharringtonine+AraC, HA) based induction therapy which composing of three chemotherapeutic drugs (HAD, HAM, HAA, HAE) in our hospital for recent 12 years. Complete remission (CR) rate, disease free survival (DFS) and overall survival (OS) of the patients were calculated. 184 patients who had karyotype results were divided into four groups according to SWOG (Southwestern Oncology Group) criteria. Differences of CR rate, DFS and OS of different groups were evaluated. The CR rate of all 243 cases was 77.4%, and 94.6% out of them were for 1~2 courses. Median DFS of the 188 CR patients was 28.5 (range from 1.0 to 153) months. DFS rates at 3 years and 5 years were 45.4%, 40.2% respectively. The median OS of 243 patients was 18.4 (range from 0.5 to 154) months. OS rates at 3 years and 5 years were 36.9%, 31.4% 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 groups. CR rate, median DFS and OS were 97.8%, 87.4 months and 89.0 months in favorable group; 81.9%, 17.6 months and 22.3 months in intermediate group; 61.5%, 9 months and 11.5 months in the adverse group; 79.3%, 29.0 months, 19.9 months in the unknown group, respectively. The differences among the four groups were statistically significant. Multivariates analyses confirmed contribution of cytogenetics and courses of post-remission chemotherapy to DFS and OS. If we incorporated unknown group into the intermediate group, the CR rate is 80.6%. DFS rates at 3 years and 5 years were 40.5%, 38.1% respectively. OS rates at 3 years and 5 years were 40.3%, 37.4% respectively. We conclude triple-drugs induction regimens based on HA are highly effective in adult AML in China. Cytogenetics is the important prognostic factor. SWOG karyotype subtyping criteria is appropriate to our patients and unknown group can be incorporated into the intermediate group.