Prognostic Parameters of Acute Myeloid Leukaemia at Presentation.

INTRODUCTION: The treatment response and outcome in acute myeloid leukaemia (AML) is heterogeneous. AIM: To analyze the prognostic parameters of AML at presentation. METHODS: The total sample of 44 AML patients was analyzed on the basis of age <55 and ≥55 years, sex, WBC count <50x10/9/l and ≥50x10/9/l, the Hb concentration <100 g/l and ≥100 g/l, PLT count <100x10/9/l and ≥100x10/9/l, Karnofsky score <60% and >60%, cytogenetics, CD56 expression, morphological type and types of treatment (standard and reduced induction chemotherapy, high-dose chemotherapy/stem cell transplantation - autologous and HLA matched, related, allogeneic, together and separately). RESULTS: The age <55 years, Karnofsky score >60% and standard induction chemotherapy statistically correlated with the higher complete remission (CR) rates, longer relapse free survival (RFS), lower relapse rate (RR), and longer overall survival (OS) (p<0.01). The difference in terms of CR and RR between the sexes were not statistically significant (p<0.05), however women had statistically lower OS comparing to men (9.71±4.54 months vs. 38.03±9.17 months) (p<0.01). WBC count ≥ 50x10/9/l and the Hb concentration <100 g/l statistically correlated with shorter OS (p<0.05), while the WBC count ≥50x10/9/l statistically correlated with shorter RFS (p<0.05). The PLT count <100x10/9/l and ≥100x10/9/l was not found as prognostically significant for CR, RR, RFS, and OS (p<0.05). In comparison to the standard induction chemotherapy, both types of high dose chemotherapy/stem cell transplantation (HDT/SCT) (10/22), together and separately, resulted in longer RFS, lower RR, and longer OS (p<0.05). The frequency of cytogenetic risk was intermediate 81.6%, unfavorable 13.2%, and favorable 5.3%, respectively. CD56 + expression statistically correlated with the lower PLT count, higher RR, shorter RFS, and shorter OS (p<0.05). Statistical analysis of the cytogenetic risk and morphological types of AML were not possible due to the small number of patients in stratified groups. CONCLUSIONS: Female sex, the WBC count >50x10/9/l, the concentration of Hb <100 g/l, and CD56 + expression, at presentation of AML, should be considered as parameters of adverse risk, especially in latter decisions considering post-remission treatment with HDT/SCT.

Myeloprolipherative disorder type chronic myeloid leukemia--eosinophilic form.

Chronic eosinophilic leukemia (CEL) is a very rare form of leucemia in the western world. Adequate response is seldomly achieved after treatment with corticosteroids, interferon-alfa (INF-alfa) and medications containing hydroxi-urea (Litalir). The study presents a patient with CEL with no initial therapeutic response to the use of corticosteroids, INF-alfa and hydroxy-urea, and with neither clinical nor hematological response. After setting a diagnosis of CEL, patient was ordinated Imatinib (Glivec tabbletes) in a daily dose of 200 mg. Two days afterwards there was an evident withdrawal of subjective and clinical symptoms of disease, and the complete blood count showed significant amendment.

Prognostic significance of bone-marrow pattern and immunophenotypic score in B-chronic lymphocytic leukemia at diagnosis.

INTRODUCTION: The clinical course and outcome of B-CLL is various and so far unpredictible. Defining prognostic parameters potentiating division of patients in groups with favorable and unfavorable prognosis which could help the benefit assessment of early treatment, improve treatment effects, and potentiate treatment modification for each patient. AIM: To analyze the bone-marrow (BM) pattern and immunophenotypic score at diagnosis of B-CLL and determine the correlation of BM pattern with the clinical stage of disease and immunophenotypic score. METHODS: A sample of 40 untreated patients with B-CLL was divided into two groups: group with clinical stage Binet A and group with clinical stages Binet B and Binet C. BM patterns were observed as a diffuse, interstitial, nodular and mixed. BM immunophenotyping included CD5, CD23, CD22, and CD20 as an indirect indicator of FMC7. RESULTS: The overall sample mean age was 62.88 years +/- 11.10, without significant difference in the age of two compared groups (63.15 +/- 10.53 years vs. 62.60 +/- 11.50 years) (t = 0.16, df= 38, p = 0.88). Proportion of men was significantly higher in stages Binet B and C (12/20) compared to stage Binet A (5/20) (Z=2.24, p=0.025). The percentage of women was higher than men in Binet A stage (75% vs. 25%). The BM patterns in Binet A stage were observed as follows: mixed 50% (10/20), interstitial 30% (6/20), nodular 15% (3/20) and diffuse 5% (1/20). The BM patterns in Binet B and C stages were observed as follows: diffuse 50% (10/20), mixed 40% (8/20), interstitial 5% (1/20) and nodular 5% (1/20). Clinical stage and the BM patterns were significantly associated (c2=8.02, p=0,005). The chance for non-diffuse patterns was 19 times higher in stage Binet A compared to stages Binet B and C, respectively, analyzing 95% CI at least 2 times higher (95% CI: 2.02-866.6). Immunophenotypic score in total sample was observed as follows: score 4: 5% (2/40), score 3: 72.5% (29/40), score 2: 20% (8/40) and score 1: 2,5% (1/40). Immunophenotypic score 3 and > 3 had 77.5% of patients (31/40), but there was no significant association between the immunophenotypic score and the BM patterns (c2=0.76, p=0.38). CONCLUSIONS: Diffuse BM pattern was significantly associated with the clinical stages Binet B and C, compared to non-diffuse BM patterns which were significantly associated with the clinical stage Binet A. Diffuse BM pattern represent the parameter of progressive disease compared to the non-diffuse BM patterns which are more often represented in stable disease. Immunophenotypic score improves diagnostic accuracy of B-CLL, but should not be used as a prognostic parameter of B -CLL.