FAVORABLE EFFECT OF PRIMING WITH GEANULOCYTE COLONY-STIMULATING FACTOR IN REMISSION INDUCTION OF HYPOCELLULAR ACUTE MYLOID LEUKEMIA
(Abstract release date: 05/21/15)
EHA Library. Colovic N. 06/12/15; 102626; PB1645
Disclosure(s): Medical Faculty University BelgradeInternal medicine
Assoc. Prof. Natasa Colovic
Contributions
Contributions
Abstract
Abstract: PB1645
Type: Publication Only
Background
Background. The hypocellular variant of acute leukemia is very rare atypical leukemia which mainly occurs in older patients. It ussually has a myeloid phenotype. Survey of Pub Med have shown that there are no guidelines in the world literature for the treatment of such subtype of AML. The effect of G-CSF priming has not been investigated as a key constituent of remission induction chemotherapy in this cohort of patients. We point out the need for such contribution of world centers to show the best way for good outcome of these rare subtype of acute myloid leukemia.
Aims
The aim was to evaluate the results of treatment with different protocols.
Methods
Material and methods. We retrospectively analyzed all hypocellular acute myeloid leukemias which were treated in ten years period, between january 1990 and december 2010 at the Clinic of Hematology, Clinical Center Belgrade. All diagnostic criteria were met: pancytopenia with blasts in peripheral blood, less than 20% of bone marrow cellularity and more than 20% of blastas in bone marrow which were myeloperoxidase positive responding to myelod phenotype. There were 30 patients, 18male 12female, The median age of the patients was 58,9 years (ranging from 32-76 years) and median cellularity of bone marrow of this group of patients was 16%. Only one patient had myelodysplastic syndrome as antecedent disorder. No one of presented patients received prior chemoradiotherapy for non-hematopoietic neoplasms.
Results
All patients at presentation had leucopenia ranging from 0.3-2.0 (with SD 0.4). The distribution according to FAB Classification were as follows: 5 patients(pts) had M0 (16%), 11 pts M1 ( 36 %), 6 M2 (20 %), M4 1pts(3 % ), M5a 2 pts( 6 %) and M7 1 pts (3 %) and 4 patients had unclassified acute myeloid leukemia. The ECOG performance status was: 17 patients had favorable performance status (1 PS was in 4 pts and 2 in 13 pts – 56,6%), status 3 in 8 (26,6 %) and 4 in 5 ( 1.3 %). Sixteen patients had a normal diploid karyotype (or –Y in one), in seven patients cytogenetic analyses were inadequate, in four patients it was not done, in one 47XY, der(13)/46,XY, and another 46,XX, t(8;20) ad finally 46,XX,add(9)(p24)[6]/46,XX[14] was found. AML M1 was the most common subtype . followed by M2 and M5a. Twelve patients received priming with G-CSF followed by standard 3+7 regimen, 5 patients GCSF plus small doses of cytosine arabinoside, 8 patients only support and 5 patients hydoxiurea. Thirteen patients (43%) achieved a complete remission, 11 treated with G-CSF followed by standard induction chemotherapy and 2 patients treated with GCSF and low doses of cytosine arabinoside. Disease free survival was from 4 months to 72 months (median 14 months). On multivariate analysis overall survival, remission duration and event free survival were comparable to other patients with acute myeloid leukemia.
Summary
This report describes a cohort of patients with hypocellular AML characterized by prominent cytopenias, older age, low bone marrow cellularity, cytogenetic findings and distribution of morphologic subtypes similar to normocellular AML. We found that patients treated with priming G-CSF achieved the best CR rate and OS which were statistically significantly longer(Log rank p<0.0001) (P<0.008) then the rest of the cohort patients.
Type: Publication Only
Background
Background. The hypocellular variant of acute leukemia is very rare atypical leukemia which mainly occurs in older patients. It ussually has a myeloid phenotype. Survey of Pub Med have shown that there are no guidelines in the world literature for the treatment of such subtype of AML. The effect of G-CSF priming has not been investigated as a key constituent of remission induction chemotherapy in this cohort of patients. We point out the need for such contribution of world centers to show the best way for good outcome of these rare subtype of acute myloid leukemia.
Aims
The aim was to evaluate the results of treatment with different protocols.
Methods
Material and methods. We retrospectively analyzed all hypocellular acute myeloid leukemias which were treated in ten years period, between january 1990 and december 2010 at the Clinic of Hematology, Clinical Center Belgrade. All diagnostic criteria were met: pancytopenia with blasts in peripheral blood, less than 20% of bone marrow cellularity and more than 20% of blastas in bone marrow which were myeloperoxidase positive responding to myelod phenotype. There were 30 patients, 18male 12female, The median age of the patients was 58,9 years (ranging from 32-76 years) and median cellularity of bone marrow of this group of patients was 16%. Only one patient had myelodysplastic syndrome as antecedent disorder. No one of presented patients received prior chemoradiotherapy for non-hematopoietic neoplasms.
Results
All patients at presentation had leucopenia ranging from 0.3-2.0 (with SD 0.4). The distribution according to FAB Classification were as follows: 5 patients(pts) had M0 (16%), 11 pts M1 ( 36 %), 6 M2 (20 %), M4 1pts(3 % ), M5a 2 pts( 6 %) and M7 1 pts (3 %) and 4 patients had unclassified acute myeloid leukemia. The ECOG performance status was: 17 patients had favorable performance status (1 PS was in 4 pts and 2 in 13 pts – 56,6%), status 3 in 8 (26,6 %) and 4 in 5 ( 1.3 %). Sixteen patients had a normal diploid karyotype (or –Y in one), in seven patients cytogenetic analyses were inadequate, in four patients it was not done, in one 47XY, der(13)/46,XY, and another 46,XX, t(8;20) ad finally 46,XX,add(9)(p24)[6]/46,XX[14] was found. AML M1 was the most common subtype . followed by M2 and M5a. Twelve patients received priming with G-CSF followed by standard 3+7 regimen, 5 patients GCSF plus small doses of cytosine arabinoside, 8 patients only support and 5 patients hydoxiurea. Thirteen patients (43%) achieved a complete remission, 11 treated with G-CSF followed by standard induction chemotherapy and 2 patients treated with GCSF and low doses of cytosine arabinoside. Disease free survival was from 4 months to 72 months (median 14 months). On multivariate analysis overall survival, remission duration and event free survival were comparable to other patients with acute myeloid leukemia.
Summary
This report describes a cohort of patients with hypocellular AML characterized by prominent cytopenias, older age, low bone marrow cellularity, cytogenetic findings and distribution of morphologic subtypes similar to normocellular AML. We found that patients treated with priming G-CSF achieved the best CR rate and OS which were statistically significantly longer(Log rank p<0.0001) (P<0.008) then the rest of the cohort patients.
Abstract: PB1645
Type: Publication Only
Background
Background. The hypocellular variant of acute leukemia is very rare atypical leukemia which mainly occurs in older patients. It ussually has a myeloid phenotype. Survey of Pub Med have shown that there are no guidelines in the world literature for the treatment of such subtype of AML. The effect of G-CSF priming has not been investigated as a key constituent of remission induction chemotherapy in this cohort of patients. We point out the need for such contribution of world centers to show the best way for good outcome of these rare subtype of acute myloid leukemia.
Aims
The aim was to evaluate the results of treatment with different protocols.
Methods
Material and methods. We retrospectively analyzed all hypocellular acute myeloid leukemias which were treated in ten years period, between january 1990 and december 2010 at the Clinic of Hematology, Clinical Center Belgrade. All diagnostic criteria were met: pancytopenia with blasts in peripheral blood, less than 20% of bone marrow cellularity and more than 20% of blastas in bone marrow which were myeloperoxidase positive responding to myelod phenotype. There were 30 patients, 18male 12female, The median age of the patients was 58,9 years (ranging from 32-76 years) and median cellularity of bone marrow of this group of patients was 16%. Only one patient had myelodysplastic syndrome as antecedent disorder. No one of presented patients received prior chemoradiotherapy for non-hematopoietic neoplasms.
Results
All patients at presentation had leucopenia ranging from 0.3-2.0 (with SD 0.4). The distribution according to FAB Classification were as follows: 5 patients(pts) had M0 (16%), 11 pts M1 ( 36 %), 6 M2 (20 %), M4 1pts(3 % ), M5a 2 pts( 6 %) and M7 1 pts (3 %) and 4 patients had unclassified acute myeloid leukemia. The ECOG performance status was: 17 patients had favorable performance status (1 PS was in 4 pts and 2 in 13 pts – 56,6%), status 3 in 8 (26,6 %) and 4 in 5 ( 1.3 %). Sixteen patients had a normal diploid karyotype (or –Y in one), in seven patients cytogenetic analyses were inadequate, in four patients it was not done, in one 47XY, der(13)/46,XY, and another 46,XX, t(8;20) ad finally 46,XX,add(9)(p24)[6]/46,XX[14] was found. AML M1 was the most common subtype . followed by M2 and M5a. Twelve patients received priming with G-CSF followed by standard 3+7 regimen, 5 patients GCSF plus small doses of cytosine arabinoside, 8 patients only support and 5 patients hydoxiurea. Thirteen patients (43%) achieved a complete remission, 11 treated with G-CSF followed by standard induction chemotherapy and 2 patients treated with GCSF and low doses of cytosine arabinoside. Disease free survival was from 4 months to 72 months (median 14 months). On multivariate analysis overall survival, remission duration and event free survival were comparable to other patients with acute myeloid leukemia.
Summary
This report describes a cohort of patients with hypocellular AML characterized by prominent cytopenias, older age, low bone marrow cellularity, cytogenetic findings and distribution of morphologic subtypes similar to normocellular AML. We found that patients treated with priming G-CSF achieved the best CR rate and OS which were statistically significantly longer(Log rank p<0.0001) (P<0.008) then the rest of the cohort patients.
Type: Publication Only
Background
Background. The hypocellular variant of acute leukemia is very rare atypical leukemia which mainly occurs in older patients. It ussually has a myeloid phenotype. Survey of Pub Med have shown that there are no guidelines in the world literature for the treatment of such subtype of AML. The effect of G-CSF priming has not been investigated as a key constituent of remission induction chemotherapy in this cohort of patients. We point out the need for such contribution of world centers to show the best way for good outcome of these rare subtype of acute myloid leukemia.
Aims
The aim was to evaluate the results of treatment with different protocols.
Methods
Material and methods. We retrospectively analyzed all hypocellular acute myeloid leukemias which were treated in ten years period, between january 1990 and december 2010 at the Clinic of Hematology, Clinical Center Belgrade. All diagnostic criteria were met: pancytopenia with blasts in peripheral blood, less than 20% of bone marrow cellularity and more than 20% of blastas in bone marrow which were myeloperoxidase positive responding to myelod phenotype. There were 30 patients, 18male 12female, The median age of the patients was 58,9 years (ranging from 32-76 years) and median cellularity of bone marrow of this group of patients was 16%. Only one patient had myelodysplastic syndrome as antecedent disorder. No one of presented patients received prior chemoradiotherapy for non-hematopoietic neoplasms.
Results
All patients at presentation had leucopenia ranging from 0.3-2.0 (with SD 0.4). The distribution according to FAB Classification were as follows: 5 patients(pts) had M0 (16%), 11 pts M1 ( 36 %), 6 M2 (20 %), M4 1pts(3 % ), M5a 2 pts( 6 %) and M7 1 pts (3 %) and 4 patients had unclassified acute myeloid leukemia. The ECOG performance status was: 17 patients had favorable performance status (1 PS was in 4 pts and 2 in 13 pts – 56,6%), status 3 in 8 (26,6 %) and 4 in 5 ( 1.3 %). Sixteen patients had a normal diploid karyotype (or –Y in one), in seven patients cytogenetic analyses were inadequate, in four patients it was not done, in one 47XY, der(13)/46,XY, and another 46,XX, t(8;20) ad finally 46,XX,add(9)(p24)[6]/46,XX[14] was found. AML M1 was the most common subtype . followed by M2 and M5a. Twelve patients received priming with G-CSF followed by standard 3+7 regimen, 5 patients GCSF plus small doses of cytosine arabinoside, 8 patients only support and 5 patients hydoxiurea. Thirteen patients (43%) achieved a complete remission, 11 treated with G-CSF followed by standard induction chemotherapy and 2 patients treated with GCSF and low doses of cytosine arabinoside. Disease free survival was from 4 months to 72 months (median 14 months). On multivariate analysis overall survival, remission duration and event free survival were comparable to other patients with acute myeloid leukemia.
Summary
This report describes a cohort of patients with hypocellular AML characterized by prominent cytopenias, older age, low bone marrow cellularity, cytogenetic findings and distribution of morphologic subtypes similar to normocellular AML. We found that patients treated with priming G-CSF achieved the best CR rate and OS which were statistically significantly longer(Log rank p<0.0001) (P<0.008) then the rest of the cohort patients.
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