Treated secondary acute myeloid leukemia: a distinct high-risk subset of AML with adverse prognosis

被引：94

作者：

Boddu, Prajwal ^{[1
]}

Kantarjian, Hagop M. ^{[1
]}

Garcia-Manero, Guillermo ^{[1
]}

Ravandi, Farhad ^{[1
]}

Verstovsek, Srdan ^{[1
]}

Jabbour, Elias ^{[1
]}

Borthakur, Gautam ^{[1
]}

Konopleva, Marina ^{[1
]}

Bhalla, Kapil N. ^{[1
]}

Daver, Naval ^{[1
]}

DiNardo, Courtney D. ^{[1
]}

Benton, Christopher B. ^{[1
]}

Takahashi, Koichi ^{[1
]}

Estrov, Zeev ^{[1
]}

Pierce, Sherry R. ^{[1
]}

Andreeff, Michael ^{[1
]}

Cortes, Jorge E. ^{[1
]}

Kadia, Tapan M. ^{[1
]}

机构：

[1] Univ Texas MD Anderson Canc Ctr, Dept Leukemia, 1515 Holcombe Blvd,Box 428, Houston, TX 77030 USA

来源：

BLOOD ADVANCES | 2017年 / 1卷 / 17期

基金：

美国国家卫生研究院;

关键词：

CYTOSINE-ARABINOSIDE THERAPY; MYELODYSPLASTIC SYNDROME; APLASTIC-ANEMIA; TRANSFORMATION; RESISTANCE; MDS; AGE; CLASSIFICATION; FREQUENCY; ADULTS;

D O I：

10.1182/bloodadvances.2017008227

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Secondary acute myeloid leukemia (s-AML) includes therapy-related AML and AML evolving from antecedent hematological disorder (AHD). s-AML arising after treating AHD likely represents a prognostically distinct, high-risk disease category. In this study, treated s-AML (ts-AML) was defined by: (1) prior diagnosis of myelodysplasia, myeloproliferative neoplasm, or aplastic anemia and (2) at least 1 therapy for that diagnosis. ts-AML was categorized by age (< or >= 60 years), and each cohort assessed for response rates and overall survival (OS) on various treatment regimens. Survival outcomes were compared against other high-risk prognostic subsets. Results showed that complete response and 8-week mortality rates were 32% and 27% in the younger, and 24% and 19% in the older age groups, respectively. There was a significant OS difference within s-AML based on prior treatment of AHD (ie, ts-AML vs s-AML with untreated AHD, 4.2 vs 9.2 months; P < .001). Survival in ts-AML was poor across both cohorts (younger and older, 5 and 4.7 months, respectively). In younger AML, survival was significantly inferior in ts-AML when compared with deletion 5/7, TP53, 3q abnormality, and therapy-related AML groups (median, 5 vs 7.9, 7.8, 7.9, and 11.2 months, respectively; P < .01). Additional adverse karyotype within ts-AML was associated with even worse outcomes (OS range, 1.6-2.8 months). ts-AML represents a very high-risk category, even in younger AML patients. s-AML should be further classified to describe ts-AML, an entity less responsive to currently applied treatment approaches. Future AML trial designs should accommodate ts-AML as a distinct subgroup.

引用

页码：1312 / 1323

页数：12

共 50 条

[1] Age and acute myeloid leukemia [J].