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P015 Outcome in a small series of biphenotypic acute leukemia (BAL) patients
Poster Sessions leukemia (AML) is poor, since the overall median survival of these patients is less than 3 months and under ten percent are long-term survivors. Response to first induction therapy is one of the most important prognostic factors and induction of complete or partial remission is the primary aim of these patients. The combination of Ara-C and athracyclines proved to be an effective induction regimen for this group of patients but there are exist a subset of patients with comorbid conditions with decreased the tolerance or contraindications to intensive chemotherapy programs. More recently, the introduction of gemtuzumab ozogamicin (GO) - anti -CD33 monoclonal antibody has opened new perspectives in the treatment of AML. Methods: We report here our preliminary experience on 5 elderly CD33+ AML patients treated as first -line therapy with ARA-GO (AraC 100mg/m2 day 1-7 continual iv infusion) followed by gentuzumab ozogamicin (6 mg/m2 ) on days 4 and 8. Responding patients received the same regimen as consolidation therapy. Patients: The median age of patients was 72 years (range, 67-72); M/F ratio was 3/2; FAB subtypes were M4 in 3 patients, M2 in 2 patient. All patients were secodary to MDS (1patient was secondary to epithelial neoplasma too). Hematological parametres before therapy were the following: WBC 4,0 × 109 /l (range 1,5-76); Hb 9,6g/dL (7,6-12); Plt 39 × 109 /l (27-140). Cytogenetic analysis revealed poor prognosis alteration in 4 patients (1 with 6 complexes karyotypes) and an intermediate alteration in the 1 patient. Results: The neutrophil (PMN>0,5 × 109 /l) and platelet (>25 × 109 /l) recovery regimen a median of 15 (range 11-21) and 17 days (range 10-27) from the end of therapy. The median number of days with fever (>38°C) was 3. Therapy has been well tolerated. Neither deaths during induction occurred nor severe infectious, hepatic or cardiac complications were recorded. The median hospitalization period was 17 days (range 10-27). 4/5 (80%) patients occurred complete remission (CR). Complete remission and survival had a median lenght of 6 months (range 6-18) and 9 months in two patients, respectively. Two patiens are in alive 3 months after consolidation therapy in CR. One patient relapsed and have died of disease. Conclusions: Considering the reported outcome of elderly AML patients treated with conventional chemotherapy and the unfavourable clinical features of this series (secondary AML and unfavourable karyotype) our results shows that ARA-GO may represent a well tolerated and effective induction and consolidation regimen for elderly non M3 AML patients.
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P015 Outcome in a small series of biphenotypic acute leukemia (BAL) patients M. Mikulic, D. Batini´c, L. Rnjak, M. Mrsi´c, D. Nemet, R. Serventi-Seiwerth, D. Serti´c, K. Dubravˇci´c, M. Golemovi´c, S. Mrsi´c, M. Suˇci´c, K. Gjadrov, R. Zadro, B. Labar. Department of Medicine, University Hospital Center Zagreb and School of Medicine, Universisty of Zagreb, Zagreb, Croatia Background: Less than 5% of all cases of acute leukemia are classified as biphenotypic acute leukemia (BAL). Being a distinct entity recognized by the WHO classification, BAL is immunophenotypically defined by the European Group for the Immunological Classification of Leukemia (EGIL) scoring system, whereas according to FAB classification BAL may present as one of the ALL or AML subtypes. Since BAL is both a rare form of acute leukemia and shows diverse biological features, there is no consensus on the best treatment approach in these patients. Aim: Our aim was to analyze the laboratory characteristics and the outcome of patients diagnosed with BAL. Patients and methods: Using the EGIL system, we identified 21 cases (4%) of BAL from 535 newly diagnosed acute leukemia patients in the Zagreb Clinical Hospital Center in the period from end 1994-2006. Results: There were 16 male and 5 female patients with median age of 44 years (16-74). Among them, there were 12 cases of B+myeloid leukemia (55%), 8 cases of T+myeloid (36%), 1 case of B+T lymphoid (5%) and 1 case of trilineage B+T+myeloid leukemia (5%). Morphologic assessment showed myeloid features in 9, lymphoid features in 6 and undifferentiated in 6 patients. Cytogenetic findings revealed normal as well as a wide range of aberrant karyotypes. The patients were treated according to the protocols for AML or ALL or with low-dose chemotherapy - 8, 10 and 3 patients, respectively. In the majority of patients overall survival was poor with a median of 7 months (1-100) and with a probability of survival at two years of 35%. Conclusion: Despite the progress in the treatment of acute leukemia, the definition and the prognosis of BAL remains poor. Current treatment approach is heterogeneous and still based on cytomorphology. Treatment protocols designed specifically for this type of leukemia should be devised and studied in larger groups of patients.
P016 Granulocytic sarcoma: single institution expirience D. Antic, D. Tomin, V. Cemerikic, M. Perunicic, I. Elezovic, N. Suvajdzic, M. Bakrac, J. Bila, M. Mitrovic, D. Boskovic. Institute of Hematology, Clinical Center of Serbia, Belgrade, Serbia Background: Granulocytic sarcoma (chloroma, myeloblastoma) with no demonstrable abnormalities in the peripheral
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P015 Outcome in a small series of biphenotypic acute leukemia (BAL) patients M. Mikulic, D. Batini´c, L. Rnjak, M. Mrsi´c, D. Nemet, R. Serventi-Seiwerth, D. Serti´c, K. Dubravˇci´c, M. Golemovi´c, S. Mrsi´c, M. Suˇci´c, K. Gjadrov, R. Zadro, B. Labar. Department of Medicine, University Hospital Center Zagreb and School of Medicine, Universisty of Zagreb, Zagreb, Croatia Background: Less than 5% of all cases of acute leukemia are classified as biphenotypic acute leukemia (BAL). Being a distinct entity recognized by the WHO classification, BAL is immunophenotypically defined by the European Group for the Immunological Classification of Leukemia (EGIL) scoring system, whereas according to FAB classification BAL may present as one of the ALL or AML subtypes. Since BAL is both a rare form of acute leukemia and shows diverse biological features, there is no consensus on the best treatment approach in these patients. Aim: Our aim was to analyze the laboratory characteristics and the outcome of patients diagnosed with BAL. Patients and methods: Using the EGIL system, we identified 21 cases (4%) of BAL from 535 newly diagnosed acute leukemia patients in the Zagreb Clinical Hospital Center in the period from end 1994-2006. Results: There were 16 male and 5 female patients with median age of 44 years (16-74). Among them, there were 12 cases of B+myeloid leukemia (55%), 8 cases of T+myeloid (36%), 1 case of B+T lymphoid (5%) and 1 case of trilineage B+T+myeloid leukemia (5%). Morphologic assessment showed myeloid features in 9, lymphoid features in 6 and undifferentiated in 6 patients. Cytogenetic findings revealed normal as well as a wide range of aberrant karyotypes. The patients were treated according to the protocols for AML or ALL or with low-dose chemotherapy - 8, 10 and 3 patients, respectively. In the majority of patients overall survival was poor with a median of 7 months (1-100) and with a probability of survival at two years of 35%. Conclusion: Despite the progress in the treatment of acute leukemia, the definition and the prognosis of BAL remains poor. Current treatment approach is heterogeneous and still based on cytomorphology. Treatment protocols designed specifically for this type of leukemia should be devised and studied in larger groups of patients.
P016 Granulocytic sarcoma: single institution expirience D. Antic, D. Tomin, V. Cemerikic, M. Perunicic, I. Elezovic, N. Suvajdzic, M. Bakrac, J. Bila, M. Mitrovic, D. Boskovic. Institute of Hematology, Clinical Center of Serbia, Belgrade, Serbia Background: Granulocytic sarcoma (chloroma, myeloblastoma) with no demonstrable abnormalities in the peripheral