Secondary cytogenetic changes in acute promyelocytic leukemia - Prognostic importance in patients treated with chemotherapy alone and association with the intron 3 breakpoint of the PML gene: A Cancer and Leukemia Group B study

J. L. Slack, D. C. Arthur, D. Lawrence, K. Mrózek, R. J. Mayer, F. R. Davey, R. Tantravahi, M. J. Pettenati, S. Bigner, A. J. Carroll, K. W. Rao, C. A. Schiffer, C. D. Bloomfield

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Abstract

Purpose: To examine, in newly diagnosed patients with acute promyelocytic leukemia (APL), the prognostic significance of secondary cytogenetic changes and the relationship between such changes and the two major promyelocytic leukemia-retinoic acid receptor alpha (PML-RARα) mRNA types. Patients and Methods: One hundred sixty-one patients with t(15; 17)(q22;q11-12) enrolled onto Cancer and Leukemia Group B (CALGB) protocol 8461, a prospective study of cytogenetics in acute myeloid leukemia (AML), were studied. Eighty of these 161 patients were treated solely with chemotherapy and evaluated for response to treatment and survival. PML- RARα, mRNA type was determined using reverse transcriptase polymerase chain reaction (RT-PCR) in 56 patients. Results: The incidence of secondary cytogenetic abnormalities was 32%. Among 80 patients treated with chemotherapy, the presence of a secondary chromosome abnormality was associated with longer complete remission (CR) duration (median, 29.9 v 15.7 months; P = .03) and longer event-free survival (EFS) duration (median, 17.0 v 12.2 months; P = .03). There was no difference in overall survival (P = .28). In a separate group of 56 patients with both cytogenetic and molecular data, 32 had the type L PML-RARα transcript (intron 6 PML breakpoint). Of these 32 patients, four (12.5%) had chromosome changes in addition to t(15; 17), whereas 12 of 20 patients (60%) with the type S PML-RARα transcript (intron 3 PML breakpoint) had secondary cytogenetic changes (P < .001). Conclusion: (1) Secondary cytogenetic changes do not confer a poor prognosis in APL patients treated with anthracycline/cytarabine (Ara-C)-based chemotherapy; and (2) A highly significant relationship exists between the PML-RARα S isoform (intron 3 PML genomic breakpoint) and secondary cytogenetic changes in APL.

Original languageEnglish (US)
Pages (from-to)1786-1795
Number of pages10
JournalJournal of Clinical Oncology
Volume15
Issue number5
DOIs
StatePublished - May 1997

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Slack, J. L., Arthur, D. C., Lawrence, D., Mrózek, K., Mayer, R. J., Davey, F. R., Tantravahi, R., Pettenati, M. J., Bigner, S., Carroll, A. J., Rao, K. W., Schiffer, C. A., & Bloomfield, C. D. (1997). Secondary cytogenetic changes in acute promyelocytic leukemia - Prognostic importance in patients treated with chemotherapy alone and association with the intron 3 breakpoint of the PML gene: A Cancer and Leukemia Group B study. Journal of Clinical Oncology, 15(5), 1786-1795. https://doi.org/10.1200/JCO.1997.15.5.1786