Clinical and laboratory features of de novo acute myeloid leukaemia with trilineage myelodysplasia

Abstract

Primary myelodysplastic syndromes progress to acute myeloid leukaemia (AML) in about 30% of cases. We have sought evidence of pre-existing trilineage myelodysplasia (TMDS) using the FAB criteria (1982) in 160 consecutive cases of primary de novo AML. TMDS was found in 24 cases (15%) including two of 33 cases of M1 (6%), four of 40 cases of M2 (10%), none of 18 cases of M3, five of 31 cases of M4 (15%), six of 30 cases of M5 (20%), all of six cases of M6 and one of two cases of M7. The median presentation bone-marrow blast-cell count in the 24 AML/TMDS cases was 53% (30-90%) and 82% (45-100%) in the 136 cases of AML without TMDS. 60% of the AML/TMDS bone-marrow aspirates contained fewer than 60% of blasts compared with only 11% of those from AML without TMDS (P less than 0.001). In AML the occurrence of symptomatic cytopenias when the marrow blast-cell count is below 60% and the peripheral blood blast-cell count is below 20% is highly correlated with dysplastic haemopoiesis (P less than 0.001).

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

“…Only 50-60% of patient with AML-MRC can achieve CR after clinical treatment [1,[6][7][8][9][10] Patients with AML-MRC reviewed in this study had an overall CR rate was 60.9% (70/115), which was lower than those of AML-NOS (77.5%, 145/187) diagnosed during the same period (P < 0.05). Since patients with history of MDS or MDS/MPN received HAG and CAG protocol, while patients with AML-NOS mainly received DA and HD-Ara-C, so the influence in results due to different treatment protocols can't be excluded.…”

“…Acute myeloid leukemia (AML) with multilineage dysplasia (MLD) was first defined by Brito-Babapulle et al [1], and later studies showed that it had a prevalence of about 20% among patients with AML. AML with MLD was included in WHO classification of AML in 2001 [2] as a separate category and was divided further into two subcategories based on presence or absence of antecedent myelodysplastic syndrome (MDS) or myelodysplastic/myeloproliferative neoplasm (MDS/MPN).…”

Allogeneic bone marrow transplantation improves the outcome of de novo AML with trilineage dysplasia (AML-TLD)

“…1,[3][4][5] AML-TLD at diagnosis was comparable to AML-nonTLD in median age, but had a higher platelet count, fewer blasts in the peripheral blood and the bone marrow, fewer patients with Auer body and less myeloperoxidase positivity of leukemic blasts. In cytogenetic analysis, interestingly, more than 60% of AML-TLD patients had a normal karyotype, and none had t(15;17), t(8;21) or inversion (16).…”

“…1,2 Although the dysplastic features seen in AML-TLD are similar to those in MDS, the absence of preceding hematological abnormality distinguishes AML-TLD from leukemias following MDS. The outcome of intensive chemotherapy for AML-TLD is usually worse in terms of the CR rate and survival than for AML-nonTLD.…”

“…The outcome of intensive chemotherapy for AML-TLD is usually worse in terms of the CR rate and survival than for AML-nonTLD. [1][2][3][4][5] We previously reported two AML-TLD patients treated with allogeneic BMT, 6 but the efficacy of allogeneic BMT for AML-TLD has not been evaluated.…”