Hypocellular acute myeloid leukemia in adults: analysis of the clinical outcome of 123 patients

Abstract

BackgroundThe hypocellular variant of acute myeloid leukemia accounts for less than 10% of all cases of adult acute myeloid leukemia. It is defined by having less than 20 percent of cellular bone marrow in a biopsy at presentation. It is unclear in the literature whether the outcome of hypocellular acute myeloid leukemia differs from that of non-hypocellular acute myeloid leukemia. Design and MethodsWe retrospectively analyzed all the cases reported to be hypocellular acute myeloid leukemia between 2000 and 2009. A second pathology review was conducted and the diagnosis was confirmed in all cases. ResultsOne hundred twenty-three (9%) patients were identified: patients with hypocellular acute myeloid leukemia were older than those with non-hypocellular acute myeloid leukemia (P=0.009) and more frequently presented with cytopenias (P<0.001). Forty-one patients with hypocellular acute myeloid leukemia had an antecedent hematologic disorder and 11 patients had received prior chemo-radiotherapy for non-hematopoietic neoplasms. On multivariate analysis, overall survival, remission duration and event-free survival were comparable to those of other patients with acute myeloid leukemia. ConclusionsThe outcome of hypocellular acute myeloid leukemia does not differ from that of non-hypocellular acute myeloid leukemia.Key words: hypocellular acute myeloid leukemia, outcome, prognosis.Citation: Al-Kali A, Konoplev S, Lin E, Kadia T, Faderl S, Ravandi F, Ayoubi M, Brandt M,Cortes JE, Kantarjian H, and Borthakur G. Hypocellular

Failure matters: unsuccessful cytogenetics and unperformed cytogenetics are associated with a poor prognosis in a population‐based series of acute myeloid leukaemia

“…Some cases with UC are undoubtedly due to insufficient number of cells in the bone marrow aspirates sent for cytogenetic analysis. This would often be the case in samples from AML with myelofibrosis and hypocelullar AML; this could possibly be remedied by the use of bone marrow biopsies . Furthermore, one cannot exclude human errors in taking the bone marrow aspirates, such as too small volumes or diluting the bone marrow cells with peripheral blood and technical problems in the laboratory.…”

Hypoplastic acute myeloid leukemia in an elderly patient. A long‐term partial remission with low‐dose prednisone and G‐CSF

“…While most cases of AML are usually hypercellular or at least normocellular, 5%‐12% of all cases of AML are of the hypocellular variety and typically called hypoplastic or hypocellular AML . Hypoplastic AML is defined by bone marrow hypocellularity (cellularity <20% in trephine biopsy specimen, although in some earlier reports cellularity <40% or even 50% was considered to be hypocellular), with increase of bone marrow blasts ≥20% and few or no blast cells in the circulating blood and peripheral blood leukopenia <4000/μL although pancytopenia is not uncommon .…”

Hypocellular acute myeloid leukemia treated with bone marrow transplantation

“…Nonetheless, Bennett and Orazi have defined hypocellular AML as low BM cellularity (<20%) and leukemic blast cells (>20%) . Hypocellular AML is not recognized as including M3 on the basis of the FAB classification, but M0–M2 (51.2%), M4–M5 (4.1%), M6–M7 (6.5%) and refractory anemia with excess blasts (RAEB; 38.2%) have been reported . Because the BM cellularity of the present patient was hypoplastic, and blast cells increased to >20% during follow up, the diagnosis was hypocellular AML.…”

“…Although the standard chemotherapy for AML is associated with a high mortality rate in hypocellular AML, standard induction chemotherapy for AML now has a high rate of induction remission and long‐term survival due to advances in supportive therapy . Yamamoto et al .…”

“…Hypocellular AML has been reported to account for approximately 10% of de novo adult AML, and 31% of cases in patients >70 years . Although cases have been reported in childhood and adolescence, occurrences in this age range are extremely rare …”