Korean J Hematol 1998; 33(3):
Published online September 30, 1998
© The Korean Society of Hematology
급성전골수성백혈병의 치료 후 골수소견과 치료반응지표
강윤희, 박찬정, 지현숙, 이규형, 이정신, 김우건, 김상희
울산대학교 의과대학 서울중앙병원 임상병리과,
울산대학교 의과대학 서울중앙병원 내과
Bone Marrow Findings and Possible Indices of Treatment Response after Chemotherapy and/or ATRA therapy in Acute Promyelocytic Leukemia
Background: For acute promyelocytic leukemia(APL), NCI criteria(1990) does not provide reliable information regarding therapeutic response. We studied APL cases in our
hospital and evaluated various criteria for their predictability of therapeutic response.
Methods: Group Ⅰ(GⅠ) included 8 APL cases treated with chemotherapy and group Ⅱ(GⅡ), 10 eases with ATRA plus chemotherapy. Four treatment response indices were;
(1) NCI criteria, (2) the percent sum of myelocyte and metamyelocyte(PSMM), (3) Differentiation Index[(myelocyte+metamyelocyte+band neutrophil+segmented
neutrophil)%/(myeloblast+promyelocyte)%,DI], and (4)Maturation Index[(metamyelocyte+band neutrophil+segmented
neutrophil)%/(myeloblast+promyelocyte+myelocyte)%, MI].
Results: Among those achieving complete remission(CR), four of GⅠand eight of GⅡ showed normocellularity or hypercellularity, two were in partial remission and three in
persistence of GⅠ by NCI criteria and one of GⅡ showed persistent Auer rods at Dl4. Applying NCI criteria, the blast plus leukemic promyelocyte as leukemic cell were
correlated well with clinical outcome. PSMM of GⅡ were relatively constant as 20 to 29.7% at D28. DI showed wide variation and Ml over 2(Nakajima, 1996) did not correlate
with CR by NCI criteria in 5 cases at Dl4 and 1 case at D28.
Conclusion: NCI criteria are the reliable predictor of CR at D28 after chemotherapy if blasts plus leukemic promyelocytes are regarded as leukemic cell while they are
inappropriate at Dl4. The persistence of Auer rods dose not exclude CR. After ATRA plus chemotherapy therapy, PSMM over 20% at D28 may be considered as a marker for CR.
Keywords Acute promyelocytic leukemia; Bone marrow findings; Treatment response;
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Korean J Hematol 1998; 33(3): 372-384
Published online September 30, 1998
Copyright © The Korean Society of Hematology.
급성전골수성백혈병의 치료 후 골수소견과 치료반응지표
강윤희, 박찬정, 지현숙, 이규형, 이정신, 김우건, 김상희
울산대학교 의과대학 서울중앙병원 임상병리과,
울산대학교 의과대학 서울중앙병원 내과
Bone Marrow Findings and Possible Indices of Treatment Response after Chemotherapy and/or ATRA therapy in Acute Promyelocytic Leukemia
Yoon Hee Kang, Chan Jeoung Park, Hyun Sook Chi, Kyoo Hyung Lee, Jung Shin Lee, Woo Kun Kim, Sang Hee Kim
Department of Clinical Pathology, Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
Abstract
Background: For acute promyelocytic leukemia(APL), NCI criteria(1990) does not provide reliable information regarding therapeutic response. We studied APL cases in our
hospital and evaluated various criteria for their predictability of therapeutic response.
Methods: Group Ⅰ(GⅠ) included 8 APL cases treated with chemotherapy and group Ⅱ(GⅡ), 10 eases with ATRA plus chemotherapy. Four treatment response indices were;
(1) NCI criteria, (2) the percent sum of myelocyte and metamyelocyte(PSMM), (3) Differentiation Index[(myelocyte+metamyelocyte+band neutrophil+segmented
neutrophil)%/(myeloblast+promyelocyte)%,DI], and (4)Maturation Index[(metamyelocyte+band neutrophil+segmented
neutrophil)%/(myeloblast+promyelocyte+myelocyte)%, MI].
Results: Among those achieving complete remission(CR), four of GⅠand eight of GⅡ showed normocellularity or hypercellularity, two were in partial remission and three in
persistence of GⅠ by NCI criteria and one of GⅡ showed persistent Auer rods at Dl4. Applying NCI criteria, the blast plus leukemic promyelocyte as leukemic cell were
correlated well with clinical outcome. PSMM of GⅡ were relatively constant as 20 to 29.7% at D28. DI showed wide variation and Ml over 2(Nakajima, 1996) did not correlate
with CR by NCI criteria in 5 cases at Dl4 and 1 case at D28.
Conclusion: NCI criteria are the reliable predictor of CR at D28 after chemotherapy if blasts plus leukemic promyelocytes are regarded as leukemic cell while they are
inappropriate at Dl4. The persistence of Auer rods dose not exclude CR. After ATRA plus chemotherapy therapy, PSMM over 20% at D28 may be considered as a marker for CR.
Keywords: Acute promyelocytic leukemia, Bone marrow findings, Treatment response,
