ABSTRACT
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.
Subject(s)
Antineoplastic Agents/therapeutic use , Cytogenetics , Gene Expression Regulation, Leukemic/genetics , Hematopoietic Stem Cell Transplantation , Induction Chemotherapy , Leukemia, Myeloid, Acute/diagnosis , Adult , Aged , Aged, 80 and over , Bosnia and Herzegovina , CD56 Antigen , Disease-Free Survival , Female , Humans , Karnofsky Performance Status , Leukemia, Myeloid, Acute/drug therapy , Leukemia, Myeloid, Acute/genetics , Leukemia, Myeloid, Acute/mortality , Male , Middle Aged , Prognosis , Prospective Studies , Remission Induction/methods , Retrospective Studies , Risk Factors , Sex Distribution , Young AdultABSTRACT
Chronic lymphatic leukemia (CLL) is the most frequent type of leukemia in western world, and a choice of treatment modality depends on current stage of disease. Clinical condition of patient considered as Binnet C stage, requires treatment. Standard polyhemiotherapy (FC protocol) does not always warrant adequate and satisfactory response. This case report reviews the patient with CLL in Binnet C stage, who did not respond on FC protocol in expected way, meaning, hematological and medullar response was not detected. Twelve weeks therapy of monoclonal antiCD52 antibody (MabCampath) was than applied, resulting in normalization of all parameters of disease activity, which was desired effect of the therapy. Administration of monoclonal antiCD52 antibody is justified in case of resistance on conventional previously applied means of therapy.
