Clinical and biological features of acute myeloid leukaemia occurring as second malignancy: GIMEMA archive of adult acute leukaemia

Abstract

Between July 1992 and June 1996, 3934 new cases of acute leukaemia were registered in the Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto (GIMEMA) Archive of Adult Acute Leukaemia. Two hundred cases (5·1%) presented with a history of primary malignancy (PM), 179 of which were acute myeloid leukaemia (AML). The median age of these cases was significantly higher than that of other primitive AML (63 years vs. 57 years; P < 0·001). The number of men was significantly lower than the number of women [74/1544 (4·8%) vs. 105/1420 (7·4%); odds ratio (OR) 0·63, 95% confidence interval (CI) 0·46–0·87; P < 0·002], as was the number of patients aged < 65 years [104/1963 (5·3%) vs. 75/1001 (7·5%); OR 0·69, 95% CI 0·50–0·95; P < 0·01]. An increased incidence of cancer was observed among first‐degree relatives of patients with AML occurring after a PM (secondary AML; sAML) [66/179 (36·9%) sAML vs. 757/2785 (27·2%) de novo AML, age adjusted; OR 2·62, 95% CI 1·07–6·42; P < 0·005]. Prevalent types of PM were breast cancer, lymphoma and Hodgkin's disease. sAML occurred after a median latency of 52 months (range 2–379). Of the 122 patients who received chemotherapy for sAML, 67 patients (55%) achieved a complete remission (CR), three a partial remission, 15 (12%) died in induction and 37 (30%) were unresponsive. The median duration of CR was 30 weeks (range 4–250). The median overall survival was 7 months (range 1–196). Comparing acute promyelocytic leukaemia with all other French–American–British (FAB) groups, a significant increase in CR achievement was observed [14/18 (77·7%) vs. 53/101 (52·4%), P < 0·046] as well as in median CR duration (55 vs. 24 months, P < 0·02). The analysis of our data suggests that not only previous chemotherapy but also genetic predisposition could play a role in the pathogenesis of sAML.

Characterization and prognostic features of secondary acute myeloid leukemia in a population‐based setting: A report from the Swedish Acute Leukemia Registry

“…Median latency times between MPN and AML were between 7 and 8 years, whereas the median latency between the malignancy and t-AML was slightly longer compared to most previous studies with 5.8 years [8,18,24,25]. Median latency between a nonmalignant disease and t-AML is seldom reported, but was shown to be 14.3 years in our cohort.…”

“…The high median age of 71 years in this study demonstrate its true population-based nature with a median age substantially higher when compared with previous reports on secondary AML [2,6,8,18,19]. The proportion of patients with secondary AML found in our study (26.4%) was also higher compared to most previous studies [3,[20][21][22].…”

Identification of a molecular signature for leukemic promyelocytes and their normal counterparts: focus on DNA repair genes

“…12 Another intriguing feature of sAPL that distinguishes it from de novo APL is the remarkable predominance of female patients including those cases developed after a cancer treated with surgery alone. 4,13 Such female patients predominance is not observed in other subtypes of sAML. This gender bias may be related to the high incidence of cancers of the female reproductive system (uterus, ovary or breast) among primary tumors in sAPL patients.…”

Therapy‐related acute lymphoblastic leukemia is more frequent than previously recognized and has a poor prognosis

“…The first, alkylating agent/RT-related leukemia, has a mean latency period of 5 to 7 years, is often preceded by myelodysplasia, and is frequently associated with complete or partial deletion of chromosome 5 or 7, and complex karyotypes. 1,2 The second, occurring in patients treated with DNA topoisomerase II inhibitors, typically has a relatively short latency period, between 1 to 3 years, and is not preceded by a myelodysplastic phase. It is usually associated with chromosomal translocation involving 11q23, the MLL gene locus; however, cases without 11q23 abnormality have been rarely described.…”