Characteristics of acute myeloid leukemia with myelodysplasia‐related changes: A retrospective analysis in a cohort of Chinese patients

Abstract

We retrospectively analyzed 449 patients with AML under the WHO classification of AML 2008 and probed implications of this classification in diagnosis and treatment of acute myeloid leukemia with myelodysplasiarelated changes (AML-MRC) among them. The clinical presentations, biological features, treatments, and prognosis of patients diagnosed with AML-MRC were analyzed and compared with those of AML not otherwise specified (AML-NOS). In all patients, 115 (25.6%) were diagnosed as AML-MRC including 64 males and 51 females with median onset age of 48 years (range from 17 to 78). Their complete remission (CR) rate was 60.9% and relapse rate was 57.1%. The observed median overall survival (OS) and disease-free survival (DFS) were 10 and 5 months, respectively, which was significantly shorter than those of AML-NOS patients (P < 0.05). The prognosis of AML-MRC patients with myelodysplastic syndrome (MDS)-related cytogenetics sole was similar to those with history of MDS or myelodysplastic/myeloproliferative neoplasm (MDS/MPN). Patients with MDS-related cytogenetic abnormalities and/or history of MDS or MDS/MPN predisposed significantly shortened CR, OS, and DFS than AML-MRC patients with only multilineage dysplasia (MLD) and AML-NOS patients (P < 0.05). Multivariate analysis showed that age, cytogenetics, and history of MDS or MDS/MPN were independent prognostic factors. Patient diagnosed as AML-MRC presented distinctive clinical and biological features. Presence of MLD does not change the prognosis.

A favorable inductive remission rate for decitabine combined with chemotherapy as a first course in <60‐year‐old acute myeloid leukemia patients with myelodysplasia syndrome features

“…It is also reported that the genes with the highest frequencies of mutation in AML‐MRC were ASXL1, TP53, RUNX1, and DNMT3A, of 21%, 28%, 12%, and 9%, which were predicted to a poor prognosis. The CR rate achieved in patients treated with the IA/DA regimen for induction chemotherapy was 63.6%, which was significantly lower than that achieved in the AML‐NOS patients (77.5%) . The 3 + 7 regimen did not achieve satisfactory results, which was the same as the results in our study.…”

“…Compared with 187 cases of AML‐NOS, Xiao‐Qian Xu et al reported that markedly lower WBC counts and hemoglobin were observed in AML with MLD and MDS‐related cytogenetic abnormality, 36.5% of which had a complex karyotype. It is also reported that the genes with the highest frequencies of mutation in AML‐MRC were ASXL1, TP53, RUNX1, and DNMT3A, of 21%, 28%, 12%, and 9%, which were predicted to a poor prognosis.…”

How I treat the older patient with acute myeloid leukemia

“…The prognosis is determined by underlying cytogenetic and molecular abnormalities. 42,43 What are the possibilities in the case a patient is classified as unfit or will not likely benefit from dose-intensive chemotherapy? LDAC (20 mg SC 23 for 10 days for 4-6 weeks) is quite commonly used in these patients in some countries but is less popular in other countries.…”

Upfront allogeneic hematopoietic cell transplantation (HCT) versus remission induction chemotherapy followed by allogeneic HCT for acute myeloid leukemia with multilineage dysplasia: A propensity score matched analysis

“…3,4 Although the prognostic impact of dysplasia in AML is a matter of debate, [3][4][5][6][7][8][9][10][11] the presence of dysplasia is a negative independent factor for achieving complete remission (CR) after induction chemotherapy. In the subgroup analyses, upfront HCT had a significantly reduced incidence of leukemia-related mortality among patients aged between 60 and 70 years, those with a lower white blood cell count at diagnosis (<3000/μL), and poor cytogenetic risk, and those who received myeloablative conditioning and cord blood transplantation.…”

“…In the subgroup analyses, upfront HCT had a significantly reduced incidence of leukemia-related mortality among patients aged between 60 and 70 years, those with a lower white blood cell count at diagnosis (<3000/μL), and poor cytogenetic risk, and those who received myeloablative conditioning and cord blood transplantation. [4][5][6]12 Even if CR is achieved, the duration of CR is usually short during post-remission chemotherapy, and the number of long-term disease-free survivors remains limited. Upfront HCT contributed to the reduced incidence of leukemia-related mortality after HCT.…”