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Clinical and biological features of favorable-risk acute myelogenous leukemia – is favorable-risk AML really favorable?

Leukemia volume 19, pages 326–328 (2005)Cite this article

Acute myelogenous leukemia is a complex and heterogeneous disease characterized by an arrest of normal hematopoetic maturation produced by a clone of karyotypically distinct neoplastic cells. The characterization of these neoplastic cells by chromosome analysis strongly predicts for response to induction therapy, risk of relapse, and overall survival.1,2,3,4 The treatment of one cytogenetic subset, acute promyelocytic leukemia, with disease-specific therapy has led to markedly improved outcome.5 There are, however, also patients with other cytogenetic subsets of AML such as involving deletions of chromosomes 5 or 7, abnormalities involving chromosome 3, or complex cytogenetics that have a low likelihood of response to conventional chemotherapy, a high risk of relapse and a low probability of prolonged survival. For such patients, no specific treatment has yet been identified.6 On the basis of the heterogeneous biology of AML, the World Health Organization has classified the disease into specific cytogenetic or molecular subsets.7 Patients with AML involving translocation of chromosomes 8 and 21, abnormalities of chromosome 16, and translocation of chromosomes 15 and 17 are typically grouped into what is termed favorable-risk AML. Our discussion will focus on the clinical definitions, as well as cytogenetic and biological features of favorable-risk AML. We will also look at prospective studies that have confirmed the distinct clinical features of favorable-risk AML and discuss post-remission therapy for this unique, cytogenetically defined subgroup.

In the early 1980s, acute myelomonocytic leukemia with abnormal eosinophils was identified by distinct abnormal bone marrow morphology, cytochemical staining, and cellular ultrastructure.8,9 This subgroup of leukemia also had a distinct abnormality involving chromosome 16. In an early study of 18 patients who were retrospectively identified among 300 patients with newly diagnosed AML, Le Beau and colleagues recognized that this group had a particularly good response to cytarabine-based induction chemotherapy. Furthermore, 10 of 17 evaluable patients remained in first complete remission at the time of the report, thus constituting a group with better than 50% likelihood of leukemia-free survival.8 In a larger study looking at results only in patients with inv(16) or t(16;16), 31 of 33 such patients had the typical morphologic features of acute myelomonocytic leukemia with abnormal eosinophils. In all, 25 patients achieved complete remission with conventional induction therapy, and nine patients remained in remission more than 2 years after diagnosis.9

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  1. Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA

    G J Schiller

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Correspondence to G J Schiller.

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This paper is part of a series of keynote addresses to be published in Leukemia. They were presented at the Acute Leukemia Forum, San Francisco, April 16th, 2004

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Schiller, G. Clinical and biological features of favorable-risk acute myelogenous leukemia – is favorable-risk AML really favorable?. Leukemia 19, 326–328 (2005). https://doi.org/10.1038/sj.leu.2403659

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