Outcomes of acute myeloid leukemia with myelodysplasia related changes depend on diagnostic criteria and therapy.
Adolescent
Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols
/ administration & dosage
Bridged Bicyclo Compounds, Heterocyclic
/ administration & dosage
Cytarabine
/ administration & dosage
Daunorubicin
/ administration & dosage
Disease-Free Survival
Female
Humans
Leukemia, Myeloid, Acute
/ diagnosis
Male
Middle Aged
Mutation
Myelodysplastic Syndromes
/ diagnosis
Neoplasm Proteins
/ genetics
Sulfonamides
/ administration & dosage
Survival Rate
Journal
American journal of hematology
ISSN: 1096-8652
Titre abrégé: Am J Hematol
Pays: United States
ID NLM: 7610369
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
03
01
2020
revised:
20
02
2020
accepted:
27
02
2020
pubmed:
1
3
2020
medline:
24
6
2020
entrez:
1
3
2020
Statut:
ppublish
Résumé
Acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) is a heterogeneous disorder defined by multilineage dysplasia, myelodysplastic syndrome (MDS)-related karyotype, or history of prior MDS. We evaluated 415 patients with AML-MRC treated from 2013 to 2018 and analyzed their clinical outcomes based on the diagnostic criteria of AML-MRC, therapy type and mutation profile. Criteria for AML-MRC included: cytogenetic abnormalities (AML-MRC-C) in 243 (59%), prior history of MDS in 75 (18%) including 47 (11%) with previously untreated MDS (AML-MRC-H) and 28 (7%) with previously treated MDS (AML-MRC-TS), and 97 (23%) with multilineage dysplasia (AML-MRC-M). Median age was 70 years (range 18-94). Among 95 evaluable patients, a total of 37 (39%) had secondary-type (ASXL1, BCOR, EZH2, SF3B1, SRSF2, STAG2, U2AF1, ZRSR2) mutations. Mutations in ASXL1, BCOR, SF3B1, SRSF2, and U2AF1 tended to appear in dominant clones. By multivariate analysis, AML-MRC subtype, age and serum LDH levels were independent predictors of outcome, with patients with AML-MRC-M (HR 0.56, CI 0.38-0.84, P = .004) and AML-MRC-H having better OS. Compared to a cohort of 468 patients with AML without MRC, patients with AML-MRC-M/AML-MRC-H had similar outcomes to those with intermediate risk AML by European LeukemiaNet criteria. Intensive therapy was associated with improved OS in patients with AML-MRC-M (HR 0.42, CI 0.19-0.94, P = .036) and with improved EFS in AML-MRC-M and AML-MRC-H (HR 0.26, CI 0.10-0.63, P = .003). This data suggests that not all diagnostic criteria for AML-MRC define high-risk patients and that specific subgroups may benefit from different therapeutic interventions.
Substances chimiques
Bridged Bicyclo Compounds, Heterocyclic
0
CPX-351
0
Neoplasm Proteins
0
Sulfonamides
0
Cytarabine
04079A1RDZ
venetoclax
N54AIC43PW
Daunorubicin
ZS7284E0ZP
Types de publication
Clinical Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
612-622Informations de copyright
© 2020 Wiley Periodicals, Inc.
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