High-Resolution Chromosomes as an Independent Prognostic Indicator in Adult Acute Nonlymphocytic Leukemia

Abstract

Using high-resolution chromosomes of bone-marrow specimens from 105 consecutive adult patients with de novo acute nonlymphocytic leukemia, we found an unusually high degree of complexity in this disorder, which may explain previous difficulties in identifying useful prognostic indicators. Specimens from 99 of the 105 patients were successfully analyzed, and 92 (93 per cent) had a chromosomal defect. Seventeen categories were identified, 12 representing a specific recurrent defect. Three of them have been found to have independent prognostic importance. Patients with an inversion 16 (9 per cent), diagnosed as having M2, M4, or M5b disease according to the morphologic classification of the French–American–British Acute Leukemia Cooperative Study Group, had a uniform and sustained complete remission and a median survival of 25 months. In contrast, 14 patients (14 percent) with complex chromosomal abnormalities and a diagnosis of M1, M2, M4, M5a, or M6 disease had a very poor prognosis. In 12 of the 14 patients efforts to achieve induction of remission failed, and the group had a median survival of 2.5 months. A third group with a trisomy 8 as the single defect (11 per cent) had an intermediate prognosis and a median survival of 10 months. With the different types of treatment for acute nonlymphocytic leukemia that are now available, we suggest that high-resolution chromosome analysis will become an important tool in selecting specific types of therapy for groups of patients with differing prognoses. (N Engl J Med 1984; 311:812–8.)