{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T04:14:14Z","timestamp":1789013654795,"version":"build-2803163510"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,4,4]],"date-time":"2017-04-04T00:00:00Z","timestamp":1491264000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Hematological Oncology"],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>We retrospectively investigated 144 patients with relapsed acute myeloid leukemia (AML) to clarify predisposing factors and the prognostic impact of acquisition of additional cytogenetic abnormalities (ACA) at the first relapse. Additional cytogenetic abnormalities are recognized as clonal evolution at the cytogenetic level. Fifty\u2010nine patients (41%) acquired ACA at the first relapse. The incidences of ACA acquisition varied depending on cytogenetic abnormalities at initial diagnosis. Multivariate analysis identified t(8;21), complex karyotype, and a duration of fewer than 12\u00a0months of complete remission as independent predisposing factors for ACA acquisition. Notably, patients with ACA acquisition showed a significantly lower second complete remission rate compared with those without ACA acquisition (20.0% vs 72.5%, respectively, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001). Furthermore, the 3\u2010year overall survival rates after the first relapse were significantly different between patients with and without ACA acquisition (8.5% vs 36.8%, respectively, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001). This prognostic significance was confirmed with multivariate analysis. The hazard ratio of ACA acquisition was similar or higher than reported prognostic factors for relapsed AML patients. These findings suggested that clonal evolution detected with conventional cytogenetic analysis at the first relapse induces severe chemo\u2010refractory characteristics in AML cells and should be considered as a potent prognostic factor when evaluating accurate prognosis in relapsed AML patients.<\/jats:p>","DOI":"10.1002\/hon.2393","type":"journal-article","created":{"date-parts":[[2017,4,5]],"date-time":"2017-04-05T17:50:38Z","timestamp":1491414638000},"page":"252-257","source":"Crossref","is-referenced-by-count":12,"title":["Clonal evolution detected with conventional cytogenetic analysis is a potent prognostic factor in adult patients with relapsed AML"],"prefix":"10.1002","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7484-7405","authenticated-orcid":false,"given":"Hiroaki","family":"Shimizu","sequence":"first","affiliation":[{"name":"Department of Medicine and Clinical Science Gunma University Graduate School of Medicine  Maebashi Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiko","family":"Yokohama","sequence":"additional","affiliation":[{"name":"Division of Blood Transfusion Service, Faculty of Medicine Gunma University Hospital  Maebashi Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuma","family":"Ishizaki","sequence":"additional","affiliation":[{"name":"Department of Medicine and Clinical Science Gunma University Graduate School of Medicine  Maebashi Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nahoko","family":"Hatsumi","sequence":"additional","affiliation":[{"name":"Leukemia Research Center Saiseikai Maebashi Hospital  Maebashi Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoru","family":"Takada","sequence":"additional","affiliation":[{"name":"Leukemia Research Center Saiseikai Maebashi Hospital  Maebashi Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayuki","family":"Saitoh","sequence":"additional","affiliation":[{"name":"Gunma University School of Health Sciences, Faculty of Medicine Gunma University  Maebashi Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toru","family":"Sakura","sequence":"additional","affiliation":[{"name":"Leukemia Research Center Saiseikai Maebashi Hospital  Maebashi Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihisa","family":"Nojima","sequence":"additional","affiliation":[{"name":"Department of Medicine and Clinical Science Gunma University Graduate School of Medicine  Maebashi Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Handa","sequence":"additional","affiliation":[{"name":"Department of Medicine and Clinical Science Gunma University Graduate School of Medicine  Maebashi Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,4,4]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V92.7.2322"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V98.5.1312"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V96.13.4075"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.06.027"},{"key":"e_1_2_8_6_1","first-page":"3619","article-title":"Evolution of karyotypes in acute nonlymphocytic leukemia","volume":"39","author":"Testa JR","year":"1979","journal-title":"Cancer Res"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/0165-4608(89)90024-1"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.leu.2402654"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.5045\/br.2013.48.1.24"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature10738"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2012.06.023"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.50.7921"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2014.117267"},{"key":"e_1_2_8_14_1","first-page":"97","article-title":"No beneficial effect from addition of etoposide to daunorubicin, cytarabine, and 6\u2010mercaptopurine in individualized induction therapy of adult acute myeloid leukemia: the JALSG\u2010AML92 study. 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