Prognostic value of the rapidity of bone marrow blast cell proliferation in adult acute lymphoblastic leukemia

The analysis of the the nucleolar organizer regions (AgNORs) was performed in 36 bone marrow biopsies of adult patients with acute lymphoblastic leukemia (ALL) to verify the prognostic role of the rapidity of cell proliferation. Patients were treated with GIMEMA ALL 0496 protocol. The mean AgNOR count for the whole series was 3.1 and was higher in Ph+ than in ALL with different karyotypes. The median overall survival (OS) for the whole series was 15.5 months, with 25% of patients alive and in continuous complete remission at 89 months. OS was longer for patients with AgNOR counts less than 3.1 (17 months) than for those with higher counts (10.2 months; p =.03). The median disease-free survival (DFS) was 13.7 months for patients with AgNOR counts less than 3.1, but only 4.2 months for those with higher counts (p =.007). At multivariate analysis AgNOR count appeared as an independent prognostic variable for both OS (p =.05) and DFS (p =.005). Rapid blast cell proliferation, as assessed by a high AgNOR count, is associated with poor OS and DFS in adult ALL. AgNOR analysis in bone marrow biopsies can offer a refinement tool in the prognostic assessment of adult ALL at diagnosis.