TY - JOUR
T1 - Chronic myelogenous leukemia in blast crisis. Analysis of 242 patients
AU - Kantarjian, Hagop M.
AU - Keating, Michael J.
AU - Talpaz, Moshe
AU - Walters, Ronald S.
AU - Smith, Terry L.
AU - Cork, Ann
AU - McCredie, Kenneth B.
AU - Freireich, Emil J.
N1 - Funding Information:
From the Departments of Hematology, Biomathematics, and Laboratory Medicine, The University of Texas M.D. Anderson Hospital and Tumor Institute at Houston, 1515 Holcombe Boulevard, Houston, Texas. This work was supported by Grant 28153 from the National Cancer Institute and the National institutes of Health, Bethesda, Maryland. Dr. Kantarjian is a Special Fellow of the Leukemia Society of America. Requests for reprints should be addressed to Dr. Hagop M. Kantarjian, M.D. Anderson Hospital and Tumor Institute, Department of Hematology, Leukemia Section, 6723 Bertner, Box 47, Houston, Texas 77030. Manuscript submitted November 11, 1986, and accepted March 13, 1987.
PY - 1987/9
Y1 - 1987/9
N2 - Two hundred forty-two patients with Philadelphia chromosome-positive chronic myelogenous leukemia in blast crisis were reviewed to identify significant biologic and prognostic associations. Twenty percent of patients had lymphoid blast crisis. Clonal evolution was present in 60 percent of patients at blast crisis and involved most frequently the development of a double Philadelphia chromosome, trisomy 8, or isochromosome 17. The overall median survival from blast crisis was 18 weeks. Patient characteristics demonstrated to have significant association with short survival were: anemia; thrombocytopenia; myeloid or undifferentiated blast cell morphology; clonal evolution involving the presence of a double Philadelphia chromosome, trisomy 8, or isochromosome 17; and low marrow blast percentage. Of 195 patients who received therapy for blast crisis, complete remission was achieved in 44 (23 percent) patients, and 24 (13 percent) patients had a partial remission or hematologic improvement. Lower complete remission rates were associated with old age, thrombocytopenia, myeloid or undifferentiated blast cell morphology, clonal evolution-especially isochromosome 17 and trisomy 8-and long interval from diagnosis to onset of blast crisis. A multivariate analysis identified two characteristics to have independent prognostic importance for both survival and remission: platelet counts and blast cell morphology. In addition, clonal evolution had additive prognostic value for survival (double Philadelphia chromosome) and for response (isochromosome 17). The beneficial association of therapy with survival was demonstrated by the significantly longer median survival of patients treated since 1981 compared with those treated earlier, even after accounting for the pretreatment prognostic factors, and by the significant improvement in survival of patients achieving remission using the "landmark" analysis technique.
AB - Two hundred forty-two patients with Philadelphia chromosome-positive chronic myelogenous leukemia in blast crisis were reviewed to identify significant biologic and prognostic associations. Twenty percent of patients had lymphoid blast crisis. Clonal evolution was present in 60 percent of patients at blast crisis and involved most frequently the development of a double Philadelphia chromosome, trisomy 8, or isochromosome 17. The overall median survival from blast crisis was 18 weeks. Patient characteristics demonstrated to have significant association with short survival were: anemia; thrombocytopenia; myeloid or undifferentiated blast cell morphology; clonal evolution involving the presence of a double Philadelphia chromosome, trisomy 8, or isochromosome 17; and low marrow blast percentage. Of 195 patients who received therapy for blast crisis, complete remission was achieved in 44 (23 percent) patients, and 24 (13 percent) patients had a partial remission or hematologic improvement. Lower complete remission rates were associated with old age, thrombocytopenia, myeloid or undifferentiated blast cell morphology, clonal evolution-especially isochromosome 17 and trisomy 8-and long interval from diagnosis to onset of blast crisis. A multivariate analysis identified two characteristics to have independent prognostic importance for both survival and remission: platelet counts and blast cell morphology. In addition, clonal evolution had additive prognostic value for survival (double Philadelphia chromosome) and for response (isochromosome 17). The beneficial association of therapy with survival was demonstrated by the significantly longer median survival of patients treated since 1981 compared with those treated earlier, even after accounting for the pretreatment prognostic factors, and by the significant improvement in survival of patients achieving remission using the "landmark" analysis technique.
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U2 - 10.1016/0002-9343(87)90754-6
DO - 10.1016/0002-9343(87)90754-6
M3 - Article
C2 - 3477958
AN - SCOPUS:0023634256
SN - 0002-9343
VL - 83
SP - 445
EP - 454
JO - The American journal of medicine
JF - The American journal of medicine
IS - 3
ER -