Differences in the chromosomal profile of AML-M0 versus AML-M1:

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1996 87: 5381-5382
Differences in the chromosomal profile of AML-M0 versus AML-M1:
response [letter; comment] [see comments]
A Cuneo, G Castoldi, JL Michaux, A Ferrant, B Chatelain, A Louwagie, AZ St Jan, M Boogaerts,
PD Cin and H Van den Berghe
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5381
CORRESPONDENCE
Differences in the Chromosomal Profile of AML-MO Versus AML-M1: Response
To the Editor:
In our study published in Blood in 1995, 26 patients with minimally differentiated acute myeloid leukemia (AML-MO) were shown
to have a different cytogenetic profile with respect to 42 patients
with AML-M1. The observed high incidence of complex karyotypes
and of unfavorable chromosome changes such as -5/5q-, -7/7q-,
and + 13 in AML-MO may provide a biologic argument partially
explaining the poor prognosis of this newly recognized entity of
leukemia.’ The study by Venditti et a12 in the January l, 1996 issue
of Blood confirms that AML-MO has an unfavorable prognosis.
However, these investigators describe similar cytogenetic features
in AML-MO and AML-MI, which is at variance with our results.
We wish to analyze three possible factors, concerning (1) patient
selection, (2) influence of environmental exposure to myelotoxic
agents, and (3) statistical analysis, that may account for the discrepant cytogenetic findings in these studies.
Twenty-six patients were selected in our analysis from approximately 700 newly diagnosed patients seen in Ferrara, Italy and in 4
Belgian Institutions. Fifteen additional patients with presumptive
diagnosis of AML-MO were excluded at centralized cytoimmunologic review.’ Thus, the incidence ofAML-MO in our multicenter
study is 3.7%. There is a very high incidence of AML-MOand AMLM1 in the study by Venditti et a l z (8.9% and 19.5%, respectively, in
256 AMLs), as compared with previous studies. The incidence of
AML-MO in 2 large series, totalling over 1,300 AML cases, ranged
between 0.1% and 4%3.4;likewise, a 16.4% and 10% incidence of
AML-M1 was recorded in the large GIMEMAEORTC trial and in
the GIMEMA study of 355 AML patients submitted to centralized
cytologic
The patients of Venditti et alz with AML-M1
also have a higher incidence of chromosome changes (75%) than
was previously reported in 97 cases of de novo AML-MI studied
at the Fourth International Workshop on Chromosomes in Leukemia
(40.2%): It is worth noting that comparative analyses of original
French-American-British (FAB) diagnoses and reviewers’ diagnoses
in the GIMEMAEORTC group showed that the most frequent disagreement (30% of total) was confined to those cases classified as
AML-M1 by refemng centers and recognized either as AML-M2
or AML with monocytic features at centralized review.’,’ The incidence of chromosome changes varies according to the FAB type
and, therefore, homogeneous application of the FAB scheme is of
critical importance for studies comparing cytogenetic and cytologic
features.
Exposure to myelotoxic agents may also influence the rate of
chromosome abnormalities in leukemia. For instance, professional
exposure to organic solvents, petroleum products, or pesticides was
recorded frequently in our cases with complex karyotypes and with
+13.
In the study by Venditti et a1: data from only 28 of 50 observed
AML-M1 are used for cytogenetic comparison with AML-MO and
criteria for patient selection are not mentioned. The number of observed cases in the different cytogenetic groups (-51-7, f13, +8,
+4,others, and normal) do not add upto the total number of patients
studied. The difference of patient distribution in three cytogenetic
categories (complex karyotype, abnormal with 1 or 2 changes, and
normal karyotype) in AML-MO versus AML-M1 approaches statistical significance (P= .09). We agree with Venditti et alz that reagents
detecting myeloperoxidase are useful in the immunologic recognition ofAML-MO; however, the importance and the exact role of
this and other markers (CD1 17 and antilysozyme) in the diagnosis
of acute leukemia is currently being tested in a prospective European
study.8
Antonio Cuneo
Gianluigi Castoldi
Institute of Hematology
University of Ferrara
Ferrara, Italy
Jean-Louis Michaux
Augustine Ferrant
Bernard Chatelain
Departments of Hematotogy
U.C.L. of Brussels and Mont-Godinne
Belgium
Andries Louwagie
Department of Hematology
A.Z. St Jan
Brugge, Belgium
Marc Boogaerts
Paola Dal Cin
Herman Van den Berghe
Institute of Hematology and Centre for Human Genetics
University of Leuven
Leuven, Belgium
REFERENCES
1. Cuneo A, Ferrant A, Michaux L,Boogaerts M, Demuynck
H, Van Orshoven A, Criel A, Stul M, Dal Cin P, Hernandez J,
From www.bloodjournal.org by guest on November 24, 2014. For personal use only.
5382
Chatelain B, Doyen C, Louwagie A, Castoldi GL, Cassiman JJ,
Van Den Berghe H: Cytogenetic profile of minimally differentiated
(FAB-MO) acute myeloid leukemia: Correlation with clinicobiologic
findings. Blood 85:3688, 1995
2. Venditti A, Del Poeta G , Stasi R, Buccisano F, Aronica G ,
Bruno A, Cox C, Maffei L, Tamburini A,Papa G , Amadori S:
Biological profile of 23 cases of minimally differentiated acute myeloid leukemia (AML-MO)and its clinical implications. Blood
87:418, 1996
3. Zittoun R,Mandelli F, Willemze R, de Witte T, Labar B, Rese
gotti L, Leoni F, Damasio E, Visani G , Papa G, Caronia F, Hayat
M, Stryckmans P, Rotoli B, Leoni P, Peetermans ME, Dardenne M,
Vegna ML, Petti MC, Solbu S, Suciu S, the European Organization
for Research and Treatment of Cancer (EORTC) and the Gruppo
Italian0 Malattie Ematologiche Maligne dell’Adulto (GIMEMA)
Leukemia cooperative groups: Autologous or allogeneic bone marrow transplantation compared with intensive chemotherapy in acute
myelogenous leukemia. N Engl J Med 332:217, 1995
CORRESPONDENCE
4. Bennett JM, Catovsky D, Daniel MT, Flandrin G , Galton DAG,
Gralnick HR. Sultan C: Proposals for the recognition of minimally
differentiated acute myeloid leukaemia. Br J Haematol 78:325, 1991
5 . Castoldi GL, Lis0 V, Fenu S, Vegna ML, Mandelli F Reproducibility of the morphological diagnostic criteria for acute myeloid
leukemia: The GIMEMA group experience. Ann Hematol 66: 171,
1993
6. Fourth International Workshop on Chromosomes in Leukemia:
Overview of association between chromosome pattern and cell morphology, age, sex and race. Cancer Genet Cytogenet 11:265, 1984
7. Castoldi GL, Cuneo A, Lanza F, Rigolin GM: Cytology and
phenotype of leukaemia. Proceedings of the 1st European Forum on
Leukemias. European School of Oncology. Bergamo, Italy, September 5-8, 1994
8. Bene’ MC, Castoldi GL, Knapp W, Ludwig WD, Matutes E,
Orfao A, van’t Veer MB, The European Group for the Immunological Characterization of Leukemias (EGIL): Proposals for the immunological classification of acute leukemias. Leukemia 9:1783, 1995