What is Which of the following is a poor prognostic factor in Acute Myeloid Leukemia (AML) and explain in detail?
Answer is A (Monosomy) Monosomy is consistently associated with an unorable or poor prognosis. Monosomy is associated with a poor prognosis Monosomy especially those involving chromosome 7 (monosomy 7) and chromosome 5 (monosomy 5) are consistently associated with poor prognosis in both adults and children with AML Deletion of X or Y chromosome is associated with a orable / intermediate prognosis 'Monosomy of the X chromosome in a female patient (loss of the Y chromosome) is the most common whole chromosome loss identified in pediatric patients with AML. This numeric abnormality is usually associated with t(8; 21) translocation and AML M2 which carry a good prognosis' - 'Childhood Leukemias' by Puri 2"d/253 `Loss of Y and X chromosomes are most frequently observed in patients with t(8; 21) which carries a ourable prognosis' - 'Blood: Principles and Practice of Hematology' 2"d/108 Nucleophosphin mutation is associated with a orable prognosis Factor Favourable Unourable Nucleophosphin mutation Present Absent t (8; 21) translocation is associated with a orable prognosis Factor Favourable Unourable Cytogenetics t(15;17), 1(8;21), inv(16) -7, del(7q), -5, del(5q), 3q21 and 3q26 abnormalities, complex karyotypes Prognostic Feature in Acute Myeloid Leukemia: Factor Favourable Unourable Clinical Age <45 yr <2yr, >60yr ECOG performance status 0-1 > I Leukemia De novo Antecedent hematologic disorder, myelodysplasia, myeloproliferative disorder Infection Absent Present Prior chemotherapy No Yes Leukocytosis <25,000/mm3 > 100,000/mm2 Serum LDH Normal Elevated Extramedullary disease Absent Present CNS disease Absent Present Cytoreduction Rapid Delayed Morphology Auer rods Present Absent Eosinophils Present Absent Megaloblastic erythroids Absent Present Dysplastic megakaryocytes Absent Present FAB type M2, M3, M4 MO, M6, M7 Surface/enzyme markers Myeloid CD34-, CDI4-, CD13- CD34+ HLA-DR Negative Positive TdT Absent Present Lymphoid Cd2+ CD7+, CD56+ Biphenotypic (2 or more lymphoid markers) Present MDR-1 Absent Cytogenetics Cytogenetics 1(15;17), 1(8;21), inv(16) -7, del(7q), -5, del(5q), 3q21 and 3q26 abnormalities, complex karyotypes Molecular markers Fms-related tyrosine kinase-3 mutation Absent Present Ecotropic viral integration site 1 expression Absent Present Mixed-lineage leukemia paial tandem duplication Absent Present Nucleophosphin mutation Present Absent CCAAT/enhancer-binding protein- a mutation Present Absent Brain and acute leukemia cytoplasmic gene expression Absent Present Vascular endothelial growth factor expression Absent Present