ANALYSIS OF ACUTE MYELOID LEUKEMIA IN SHOWA UNIVERSITY HOSPITAL IN PAST TEN YEARS
We retrospectively analyzed the pathology and prognosis of 111 pts with acute myeloid leukemia （AML） in the past 10 years in the Showa University Hospital; 52.2％ of the patients was over 65 years old and 28.8％ had a diagnosis of AML with MRC. Overall survival （OS） was 34.5％ and median survival time...
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| Published in | Journal of The Showa University Society Vol. 79; no. 6; pp. 725 - 733 |
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| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
The Showa University Society
2020
昭和大学学士会 |
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| Online Access | Get full text |
| ISSN | 2187-719X 2188-529X |
| DOI | 10.14930/jshowaunivsoc.79.725 |
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| Abstract | We retrospectively analyzed the pathology and prognosis of 111 pts with acute myeloid leukemia （AML） in the past 10 years in the Showa University Hospital; 52.2％ of the patients was over 65 years old and 28.8％ had a diagnosis of AML with MRC. Overall survival （OS） was 34.5％ and median survival time was 22 months. Multivariate analysis showed that age and gender significantly influenced OS of patients. Except for t（15；17）, the significance of karyotype was limited. SCT did not significantly improve OS of AML. Introduction of a further targeted therapy based on the molecular pathology and a decrease non-relapse mortality in SCT appeared to be important to improve survival of AML of high age elderly. |
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| AbstractList | We retrospectively analyzed the pathology and prognosis of 111 pts with acute myeloid leukemia （AML） in the past 10 years in the Showa University Hospital; 52.2％ of the patients was over 65 years old and 28.8％ had a diagnosis of AML with MRC. Overall survival （OS） was 34.5％ and median survival time was 22 months. Multivariate analysis showed that age and gender significantly influenced OS of patients. Except for t（15；17）, the significance of karyotype was limited. SCT did not significantly improve OS of AML. Introduction of a further targeted therapy based on the molecular pathology and a decrease non-relapse mortality in SCT appeared to be important to improve survival of AML of high age elderly. We retrospectively analyzed the pathology and prognosis of 111 pts with acute myeloid leukemia （AML） in the past 10 years in the Showa University Hospital; 52.2％ of the patients was over 65 years old and 28.8％ had a diagnosis of AML with MRC. Overall survival （OS） was 34.5％ and median survival time was 22 months. Multivariate analysis showed that age and gender significantly influenced OS of patients. Except for t（15；17）, the significance of karyotype was limited. SCT did not significantly improve OS of AML. Introduction of a further targeted therapy based on the molecular pathology and a decrease non-relapse mortality in SCT appeared to be important to improve survival of AML of high age elderly. 急性骨髄性白血病（AML）の治療戦略は，①治癒的多剤併用化学療法，②白血病細胞の分子異常に基づく層別化と分子標的治療の導入，③同種造血幹細胞移植によりなる．一方AML患者の高年齢化はAMLの病型診断やその治療選択に大きな影響を与える．過去10年間，昭和大学病院血液内科で治療をうけた111例のAML患者の病態と治療予後を後方視的に解析し，成人AMLの実診療の現状と治療上の問題点を明らかにすることを試みた．病型分類ではAML with MRC（骨髄異形成症候群関連所見を伴うAML）が28.8％，年齢では65歳以上が52.2％で，男女比は1.85であった．全生存率は34.5％で生存中央値は22か月であった．多変量解析では治療予後に影響する因子として高年齢（75歳以上）と性別（男性）が予後不良因子として抽出された．従来予後予測に有用とされていた白血病細胞の染色体核型の治療予後への影響はt（15；17）を除けば限定的であり，同種造血幹細胞移植（SCT）の意義も明らかではなかった．AML with MRCの病態解明・治療法の確立，核型に遺伝子異常を加えたAMLのさらなる層別化治療，SCTの治療関連毒性の制御が実臨床での治療予後改善に重要と考えられた． |
| Author | ARAI, Nana NAKAMAKI, Tsuyoshi WATANUKI, Megumi FUJIWARA, Shun TSUKAMOTO, Hiroyuki YANAGISAWA, Kouji SAITO, Bungo HATTORI, Norimichi |
| Author_FL | 藤原 峻 中牧 剛 齋藤 文護 荒井 奈々 塚本 裕之 服部 憲路 柳沢 孝次 綿貫 めぐみ |
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| Author_xml | – sequence: 1 fullname: FUJIWARA, Shun organization: Department of Medicine, Division of Hematology, Showa University School of Medicine – sequence: 1 fullname: TSUKAMOTO, Hiroyuki organization: Department of Medicine, Division of Hematology, Showa University School of Medicine – sequence: 1 fullname: SAITO, Bungo organization: Department of Medicine, Division of Hematology, Showa University School of Medicine – sequence: 1 fullname: HATTORI, Norimichi organization: Department of Medicine, Division of Hematology, Showa University School of Medicine – sequence: 1 fullname: ARAI, Nana organization: Department of Medicine, Division of Hematology, Showa University School of Medicine – sequence: 1 fullname: NAKAMAKI, Tsuyoshi organization: Department of Medicine, Division of Hematology, Showa University School of Medicine – sequence: 1 fullname: WATANUKI, Megumi organization: Department of Medicine, Division of Hematology, Showa University School of Medicine – sequence: 1 fullname: YANAGISAWA, Kouji organization: Department of Medicine, Division of Hematology, Showa University School of Medicine |
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| References | 10） Dohner H, Estey EH, Amadori S, et al. Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet. Blood. 2010;115:453-474. 8） Asou N, Kishimoto Y, Kiyoi H, et al. A randomized study with or without intensified maintenance chemotherapy in patients with acute promyelocytic leukemia who have become negative for PML-RARalpha transcript after consolidation therapy: the Japan Adult Leukemia Study Group （JALSG） APL97 study. Blood. 2007;110:59-66. 15） Duval M, Klein JP, He W, et al. Hematopoietic stem-cell transplantation for acute leukemia in relapse or primary induction failure. J Clin Oncol. 2010;28:3730-3738. 2） Miyawaki S. Clinical studies of acute myeloid leukemia in the Japan Adult Leukemia Study Group. Int J Hematol. 2012;96:171-177. 17） Lin HX, Sjaarda J, Dyck J, et al. Gender and BCR-ABL transcript type are correlated with molecular response to imatinib treatment in patients with chronic myeloid leukemia. Eur J Haematol. 2016;96:360-366. 7） Grimwade D, Walker H, Oliver F, et al. The importance of diagnostic cytogenetics on outcome in AML: analysis of 1,612 patients entered into the MRC AML 10 trial. The medical research council adult and children’s leukaemia working parties. Blood. 1998;92:2322-2333. 9） Chihara D, Ito H, Matsuo K. Epidemiology of hematologic malignancy in Japan. Nihon Rinsho. 2012;70 Suppl 2:13-18. 14） Fenaux P, Mufti GJ, Hellstrom-Lindberg E, et al. Efficacy of azacitidine compared with that of conventional care regimens in the treatment of higher-risk myelodysplastic syndromes: a randomized, open-label, phase Ⅲ study. Lancet Oncol. 2009;10:223-232. 6） Kuriyama K, Yoshida S, Imanishi D, et al. Scoring systems for predicting prognoses of the patients with AML treated according to the Japan Adult Leukemia Study Group （JALSG） protocols. Rinsho Ketsueki. 1998;39:98-102. 12） The Cancer Genome Atlas Research Network. Genomic and epigenomic landscapes of adult de novo acute myeloid leukemia. N Engl J Med. 2013;368:2059-2074. 16） Ugai T, Matsuo K, Sawada N, et al. Smoking and subsequent risk of leukemia in Japan: the Japan public health center-based prospective study. J Epidemiol. 2017;27:305-310. 5） Fenaux P, Mufti GJ, Hellstrom-Lindberg E, et al. Azacitidine prolongs overall survival compared with conventional care regimens in elderly patients with low bone marrow blast count acute myeloid leukemia. J Clin Oncol. 2010;28:562-569. 11） Schlenk RF, Dohner K, Krauter J, et al. Mutations and treatment outcome in cytogenetically normal acute myeloid leukemia. N Engl J Med. 2008;358:1909-1918. 3） Bennett JM, Catovsky D, Daniel MT, et al. Proposed revised criteria for the classification of acute myeloid leukemia. A report of the French-American-British Cooperative Group. Ann Intern Med. 1985;103:620-625. 13） Silverman LR, Demakos EP, Peterson BL, et al. Randomized controlled trial of azacitidine in patients with the myelodysplastic syndrome: a study of the cancer and leukemia group B. J Clin Oncol. 2002;20:2429-2440. 1） Skipper He. Perspectives in cancer chemotherapy: therapeutic design. Cancer Res. 1964;24:1295-1302. 4） Swerdlow SH, ed. WHO classification of tumours of haematopoietic and lymphoid tissues. Lyon: International Agency for Research on Cancer; 2008. 18） Al-Sawaf O, Robrecht S, Bahlo J, et al. Impact of gender on outcome after chemoimmunotherapy in patients with chronic lymphocytic leukemia: a meta-analysis by the German CLL study group. Leukemia. 2016;31:2251-2253. |
| References_xml | – reference: 16） Ugai T, Matsuo K, Sawada N, et al. Smoking and subsequent risk of leukemia in Japan: the Japan public health center-based prospective study. J Epidemiol. 2017;27:305-310. – reference: 15） Duval M, Klein JP, He W, et al. Hematopoietic stem-cell transplantation for acute leukemia in relapse or primary induction failure. J Clin Oncol. 2010;28:3730-3738. – reference: 10） Dohner H, Estey EH, Amadori S, et al. Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet. Blood. 2010;115:453-474. – reference: 7） Grimwade D, Walker H, Oliver F, et al. The importance of diagnostic cytogenetics on outcome in AML: analysis of 1,612 patients entered into the MRC AML 10 trial. The medical research council adult and children’s leukaemia working parties. Blood. 1998;92:2322-2333. – reference: 1） Skipper He. Perspectives in cancer chemotherapy: therapeutic design. Cancer Res. 1964;24:1295-1302. – reference: 12） The Cancer Genome Atlas Research Network. Genomic and epigenomic landscapes of adult de novo acute myeloid leukemia. N Engl J Med. 2013;368:2059-2074. – reference: 18） Al-Sawaf O, Robrecht S, Bahlo J, et al. Impact of gender on outcome after chemoimmunotherapy in patients with chronic lymphocytic leukemia: a meta-analysis by the German CLL study group. Leukemia. 2016;31:2251-2253. – reference: 4） Swerdlow SH, ed. WHO classification of tumours of haematopoietic and lymphoid tissues. Lyon: International Agency for Research on Cancer; 2008. – reference: 17） Lin HX, Sjaarda J, Dyck J, et al. Gender and BCR-ABL transcript type are correlated with molecular response to imatinib treatment in patients with chronic myeloid leukemia. Eur J Haematol. 2016;96:360-366. – reference: 5） Fenaux P, Mufti GJ, Hellstrom-Lindberg E, et al. Azacitidine prolongs overall survival compared with conventional care regimens in elderly patients with low bone marrow blast count acute myeloid leukemia. J Clin Oncol. 2010;28:562-569. – reference: 11） Schlenk RF, Dohner K, Krauter J, et al. Mutations and treatment outcome in cytogenetically normal acute myeloid leukemia. N Engl J Med. 2008;358:1909-1918. – reference: 3） Bennett JM, Catovsky D, Daniel MT, et al. Proposed revised criteria for the classification of acute myeloid leukemia. A report of the French-American-British Cooperative Group. Ann Intern Med. 1985;103:620-625. – reference: 9） Chihara D, Ito H, Matsuo K. Epidemiology of hematologic malignancy in Japan. Nihon Rinsho. 2012;70 Suppl 2:13-18. – reference: 2） Miyawaki S. Clinical studies of acute myeloid leukemia in the Japan Adult Leukemia Study Group. Int J Hematol. 2012;96:171-177. – reference: 14） Fenaux P, Mufti GJ, Hellstrom-Lindberg E, et al. Efficacy of azacitidine compared with that of conventional care regimens in the treatment of higher-risk myelodysplastic syndromes: a randomized, open-label, phase Ⅲ study. Lancet Oncol. 2009;10:223-232. – reference: 6） Kuriyama K, Yoshida S, Imanishi D, et al. Scoring systems for predicting prognoses of the patients with AML treated according to the Japan Adult Leukemia Study Group （JALSG） protocols. Rinsho Ketsueki. 1998;39:98-102. – reference: 8） Asou N, Kishimoto Y, Kiyoi H, et al. A randomized study with or without intensified maintenance chemotherapy in patients with acute promyelocytic leukemia who have become negative for PML-RARalpha transcript after consolidation therapy: the Japan Adult Leukemia Study Group （JALSG） APL97 study. Blood. 2007;110:59-66. – reference: 13） Silverman LR, Demakos EP, Peterson BL, et al. Randomized controlled trial of azacitidine in patients with the myelodysplastic syndrome: a study of the cancer and leukemia group B. J Clin Oncol. 2002;20:2429-2440. |
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| SubjectTerms | acute myeloid leukemia （AML） aging AML with MRC targeted therapy 層別化治療 急性骨髄性白血病 高年齢化 |
| Title | ANALYSIS OF ACUTE MYELOID LEUKEMIA IN SHOWA UNIVERSITY HOSPITAL IN PAST TEN YEARS |
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