Journal of Clinical Oncology, Vol 3, 799-808, Copyright © 1985 by American Society of Clinical Oncology
DNA-RNA measurements in patients with acute leukemia undergoing remission induction therapy
AM Maddox, DA Johnston, B Barlogie, E Youness, M Keating and EJ Freireich
Prior to therapy, 111 newly diagnosed adult patients with acute leukemia
had DNA content measured (cell-cycle distributions) and 91 had RNA content
measured using flow cytometry of acridine orange-stained bone marrow
biopsies. The RNA index (RI) (ratio of mean RNA in G0/G1 of the sample to
the median RNA in G0/G1 of normal lymphocytes) distinguished acute
myelogenous leukemia (AML) from acute lymphocytic leukemia (ALL). The mean
RI in AML was 2.2 and in ALL 1.5. RI did not predict for achievement of
complete remission (CR). In AML the mean S- phase percent was 11.2 in
patients who achieved CR and 13.1 in those who failed to respond to
therapy, whereas in ALL it was 14.5 in those responding and 8.0 in those
not responding (P = .02). In the 77 patients with either AML or ALL who
achieved CR, a low pretreatment S- phase percent and a high RI correlated
with a long duration of CR. S- phase percent and RI were also measured
during remission induction and during maintenance therapy. Between days 8
and 18, the RI of responders decreased. In both AML and ALL an increase in
S-phase percent between days 18 and 22, prior to morphological CR, was
observed in responders but not in nonresponders. The mean S-phase percent
at the time of morphological remission was 17.3. A high S-phase percent at
this time correlated with a longer duration of CR. Although neither
pretreatment S-phase percent nor RI was found to predict for achievement of
CR in AML, both predicted for length of CR. Increases in S-phase percent
during therapy indicated recovery of normal hematopoiesis.
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