A simple, robust, validated and highly predictive index for the determination of risk‐directed therapy in acute myeloid leukaemia derived from the MRC AML 10 trial

  title={A simple, robust, validated and highly predictive index for the determination of risk‐directed therapy in acute myeloid leukaemia derived from the MRC AML 10 trial},
  author={Keith Wheatley and Alan K Burnett and Anthony H. Goldstone and Richard Gray and Ian M. Hann and Christine J. Harrison and John K. H. Rees and Richard F. Stevens and Helen Walker},
  journal={British Journal of Haematology},
Data on 1711 patients, aged up to 55 years, in the MRC AML 10 trial were used to create a prognostic index for use in risk‐directed therapy decision making for younger patients with acute myeloid leukaemia (AML). Two parameters, response after course 1 and cytogenetics, were strongly predictive of outcome. For patients with complete remission, partial remission and resistant disease, 5‐year survival from the start of course 2 was 53%, 44% and 22% and relapse rates were 46%, 48% and 69… 

The predictive value of hierarchical cytogenetic classification in older adults with acute myeloid leukemia (AML): analysis of 1065 patients entered into the United Kingdom Medical Research Council AML11 trial.

This study suggests that hierarchical cytogenetic classification identifies biologically distinct subsets of AML that are represented in all age groups, and highlights the importance of karyotype as a critical independent determinant of outcome in older patients with AML.

Prognostic factor analysis of the survival of elderly patients with AML in the MRC AML11 and LRF AML14 trials

The risk factors for survival in older AML patients were similar to those in younger ones and discrimination of patient groups with relatively good to very poor prognosis was possible, although survival in all groups was very poor in AML14NI.

Pretreatment cytogenetics add to other prognostic factors predicting complete remission and long-term outcome in patients 60 years of age or older with acute myeloid leukemia: results from Cancer and Leukemia Group B 8461.

Pretreatment cytogenetics adds to other prognostic factors in older AML patients, and patients with complex > or = 5 appear to benefit minimally from current treatment and are better suited for investigational therapy or supportive care.

The value of allogeneic bone marrow transplant in patients with acute myeloid leukaemia at differing risk of relapse: results of the UK MRC AML 10 trial

There was a survival advantage only in patients of intermediate risk in the Acute Myeloid Leukaemia 10 trial, and this trial found no survival advantage in children, patients over 35’years or good‐risk disease.

Refinement of cytogenetic classification in acute myeloid leukaemia: Determination of prognostic significance of rarer recurring chromosomal abnormalities amongst 5,876 younger adult patients treated in the UK Medical Research Council trials

Diagnostic karyotype provides the framework for risk-stratification schemes in acute myeloid leukemia (AML); however, the prognostic significance of many rare recurring cytogenetic abnormalities

Impact of early remission by induction therapy on allogeneic stem cell transplantation for acute myeloid leukemia with an intermediate‐risk karyotype in first complete remission

Data from a retrospectively examined the prognostic impact of early remission (ER) vs. delayed remission (DR) in a cohort of 132 AML patients with an intermediate‐risk karyotype undergoing allogeneic stem cell transplantation (alloSCT) in first complete remission (CR1) indicate that the rapid achievement of remission predicts a favorable outcome in patients with intermediate‐ risk AML undergoing alloSCT in CR1.

Prognostic index for adult patients with acute myeloid leukemia in first relapse.

The prognostic index estimates the outcome of AML patients in first relapse using four commonly applied clinical parameters and might identify patients who are candidates for salvage and investigational therapy.

Acute myeloid leukemia: treatment of adults under 60 years.

  • A. Burnett
  • Medicine
    Reviews in clinical and experimental hematology
  • 2002
Analysis within risk groups suggests that transplant is not indicated in good risk disease and continues to require evaluation in standard or poor risk patients, and it is probable that traditional dose intensification has now reached its limits of tolerability, so new approaches will be required.

Prognostic impact of day 15 blast clearance in risk-adapted remission induction chemotherapy for younger patients with acute myeloid leukemia: long-term results of the multicenter prospective LAM-2001 trial by the GOELAMS study group

A risk- adapted remission induction regimen in which a second course of intermediate-dose cytarabine was delivered after standard “7+3” only if patients had 5% or more bone marrow blasts 15 days after chemotherapy initiation was designed, identifying d15-blasts and cytogenetic risk as independent prognostic factors for the three end points.

Results of risk‐adapted therapy in acute myeloid leukaemia. A long‐term population‐based follow‐up study

A risk‐adapted therapy aiming at early allogeneic SCT in patients with a high risk of relapse is hampered by induction deaths, refractory disease, and early relapses; and high WBC count at diagnosis is confirmed as a strong risk factor for early death but not for relapse.



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.

Subgroup analysis demonstrated that the three cytogenetically defined prognostic groups retained their predictive value in the context of secondary as well as de novo AML, within the pediatric age group and furthermore were found to be a key determinant of outcome from autologous or allogeneic bone marrow transplantation (BMT) in first CR.

P‐glycoprotein expression on acute myeloid leukaemia blast cells at diagnosis predicts response to chemotherapy and survival

The results confirm the prognostic value of Pgp expression in AML at diagnosis and suggest that Pgp could be a useful therapeutic target for reversing multi‐drug resistance.

Establishing the presence of the t( 15; 17) in suspected acute promyelocytic leukaemia: cytogenetic, molecular and PML immunofluorescence assessment of patients entered into the M.R.C. ATRA trial

Although PML immunofluorescence staining is suitable for rapid determination of patients likely to benefit from ATRA, this approach does not obviate the need for cytogenetic and RT-PCR analysis of all patients entered into APL clinical trials, because both techniques provide additional information which may prove to be of independent prognostic significance.

Randomized comparison of DAT versus ADE as induction chemotherapy in children and younger adults with acute myeloid leukemia. Results of the Medical Research Council's 10th AML trial (MRC AML10). Adult and Childhood Leukaemia Working Parties of the Medical Research Council.

DAT and ADE both achieve high remission rates and good long-term survival, and are equally effective chemotherapy regimens for the treatment of AML patients aged up to 55 years.

Report of the National Cancer Institute-sponsored workshop on definitions of diagnosis and response in acute myeloid leukemia.

  • B. ChesonP. Cassileth M. Keating
  • Medicine, Biology
    Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • 1990
The National Cancer Institute sponsored a workshop to develop a set of standardized diagnostic and response criteria for acute myeloid leukemia (AML) clinical trials, and definitions of response for clinical trials are presented to facilitate comparisons among different studies.

Quality of life in patients with acute myelogenous leukemia in prolonged first complete remission after bone marrow transplantation (allogeneic or autologous) or chemotherapy: a cross-sectional study of the EORTC-GIMEMA AML 8A trial

Results, confirming a higher risk of permanent impairment of QOL after BMT, may have an impact on medical decisions and warrant further studies.

Effect of all transretinoic acid in newly diagnosed acute promyelocytic leukemia. Results of a multicenter randomized trial. European APL 91 Group

It is strongly suggested that ATRA should be incorporated in the front line therapy of newly diagnosed APL, as EFS was significantly higher in the ATRA group than in the chemotherapy group.

Proposals for the Classification of the Acute Leukaemias French‐American‐British (FAB) Co‐operative Group

Summary. A uniform system of classification and nomenclature of the acute leukaemias, at present lacking, should permit more accurate recording of the distribution of cases entered into clinical

Age- and gender-related heterogeneity of cancer chromosome aberrations.