Prospective study on prognostic significance of DNA ploidy and Ki-67 expression in colorectal cancer

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Background: The prognostic value of flow cytometry DNA ploidy and Ki-67 expression in colorectal carcinomas has not been defined yet. The study tries to correlate tumoral DNA ploidy and proliferative activity (Ki-67) with therapy response, Overall Survival (OS), Disesase Specific Survival (DSS) and Disease Free Survival (DFS). Methods: From 01/09/02 to 30/06/05, 3 samples of cancer tissue and 1 sample of normal mucosa has been collected from all operating pieces of colorectal cancer. These samples were frosen and later disgregated, treated and coloured with Propidium Iodide. DNA ploidy was evaluated by FACSCalibur cytofluorimetry. Normal mucosa tissue was our internal control. Ki-67 was evaluated by immuno-histochemistry in all tumoral samples. All the patients were cured with chemo- and/or radiotherapy in our divisions. Results: 67 patients (M/F 35/32); median age was 70; staging: 19% I, 33% II, 30% III, 18% IV. We found aneuploidy in 65,7% of carcinoma and Ki-67 median expression was 55%. DNA tumoral heterogeneity was present in 27% of patients. DNA aneuploidy correlates with advanced disease stage at diagnosis (p<0,01), with high number of metastatic lymphnodes (p<0,005) and with serological markers positivity (p<0,04). After surgery and chemotherapy 35% of the patients with aneuploid carcinoma and high proliferative activity (Ki-67>55%) do not show evident disease versus 100% of patients with DNA diploidy and lower Ki-67. Tumoral aneuploidy correlates in a significative way with lower OS (48% vs 89% of diploid patients), lower DSS (tumor death happened just in patients with aneuploid DNA in every disease stages), with lower DFS (18% vs 86% of diploid patients). Univariated analysis stated that aneuploidy determinates an Odd Ratio=5,7 to develop disease progression (p=0,033). At the moment Ki-67 expression with 55% cut-off does not seem to correlate with OS, DSS and DFS. Conclusions: Preliminar results (the study is still in progress) seem to suggest that cytofluorimetric DNA-ploidy has a prognostic and predictive significance in colo-rectal carcinomas. Ki-67 expression (immuno-histochemistry) has an uncertain significance. The small number of patients and the short follow-up do not allow us to reach any definitive conclusions, but the study is worth to go on.

No significant financial relationships to disclose.

Prospective study on prognostic significance of DNA ploidy and Ki-67 expression in colorectal cancer

The aim of the study was to correlate tumoral DNA ploidy and Ki-67 expression with therapy response, Overall Survival (OS), Disease Specific Survival (DSS) and Disease Free Survival (DFS). Three samples of colorectal cancer were collected from each patient. One sample of normal tissue was our internal control. DNA ploidy was evaluated by FACSCalibur cytometer and Ki-67 by immunohistochemistry. We studied 67 patients and we found aneuploidy in 65,7 percent of carcinoma with a Ki-67 median expression of 55 percent. After surgery and chemotherapy in 35 percent of the patients with aneuploid carcinoma and high proliferative activity (Ki-67 greater than 55 percent) there were no evidence of disease versus 100 percent of patients with DNA diploidy and low proliferative activity (Ki-67 less than 55 percent). Tumoral aneuploidy significantly correlated with lower OS, DSS and DFS (18 percent vs 86 percent at 30 months). Univariated analysis demonstrated a significant correlation between aneuploidy and develop disease progression (p=0,033, odd ratio=5.7), while the cut-off of 55 percent for Ki-67 expression did not correlate with OS, DSS and DFS. Preliminary results (the study is still in progress) seemed to suggest that DNA ploidy has a prognostic and predictive significance in colorectal carcinoma.

Efficacy and feasibility of intensive induction therapy in very elderly patients with acute myeloid leukaemia

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Background: Intensive Induction Treatment (IIT) increases chances of longer survival in acute myeloid leukaemia (AML). Our aim was to improve outcome and to evaluate safety and tolerability of IIT in very elderly patients (pts). Otherwise they have a median surviving time of 11 weeks without treatment. Methods: From October 2003 to November 2005 we treated 23 pts, 16 Males (M) and 7 Female (F); median age 75.5 years (range 68–95). According FAB classification they were 1 M0, 10 M1, 5 M2, 6 M4, 1 M5. ECOG performance status (PS) was 0 in 6 pts, 1 in 5 pts, 2 in 7 pts and 3 in 5 pts. All pts underwent IIT with different schedules: only a female 95 years old had less intensive treatment. Immune-chemotherapy was also admitted. Schedules were: 3+7 IDA+ARA-C in 8 pts; MY-FLAI in 7 pts; VP+ARA-C 1 = ≥ 5 in 2 pts; IDA+ARA-C 1 = ≥ 2 in 4 pts; ARA-C + 6TG in 1 pt. Eleven pts underwent second line treatment. Results: Five pts are alive and 18 dead. We obtained 7 complete responses (CR) (32%) and 1 partial response (PR) (RR 36%);. The median CR duration was 7.5 months (range 1–12).Throughout IIT we observed 5 toxic deaths (23%) because of infections and 2 deaths not leukaemia therapy related (heart failure). The median Overall Survival (OS) was 9 months. Conclusions: Despite the toxic deaths due to the treatment, we obtained in 32% of the pts CR longer compared to palliative or best supportive care; also the median OS was longer than we can expected without chemotherapy. Our data support in our opinion the feasibility and the utility of an IIT in very elderly patients with good PS.

No significant financial relationships to disclose.

Intensive chemotherapy followed by donor PBSC in ANLL relapsed after allogeneic BMT

We describe a 42-year-old man with ANLL-M4 in relapse after allogeneic BMT, in whom a new CR was obtained by conventional chemotherapy followed by the infusion of his female donor PBSC. At the time of BMT he was in CR. Six months later a full hematological relapse occurred an a three drug 5-day regimen was started. Two days after the end of chemotherapy he received donor PBSC collected by two leukaphereses after mobilization with G-CSF, given subcutaneously at 5 micrograms/kg/day for 7 days. The mononuclear PBSC were 4.2 x 10(8)/kg; the CD34 positive cells were 8.2 x 10(6)/kg and the CFU-GM were 14 x 10(4)/kg. Two days after PBSC infusion the patient received G-CSF at a dose of 5 micrograms/kg/day. Hemopoietic recovery occurred promptly on day + 13 and Y-FISH revealed 14% of Y-spot positive cells in the marrow. On day +20 hematological and cytogenetic remission was documented. The percentage of recipient cells decreased from day +36 onwards following the occurrence of a grade II GVHD, from which the patient recovered 1 week later with oral cyclosporin A and intravenous high-dose steroids. At present (day +200 from relapse) the patient is still in CR with 3% of Y-spot positive cells.