Survival after Pure (Acute) Erythroid Leukemia in the United States: A SEER-Based Study

Abstract

Background: Acute erythroid leukemia (AEL), also known as pure erythroid leukemia, is a rare subtype of acute myeloid leukemia (AML) characterized by the proliferation of malignant erythroid precursors. Outcome data at the population level are scarce. Methods: We performed a retrospective analysis of the Surveillance Epidemiology and End Results (SEER) database. All cases with a histologically confirmed diagnosis of acute (pure) erythroid leukemia during the period of 2000–2019 were included in the study. The Kaplan–Meier method was used to perform survival analysis. The significance of differences between overall survival (OS) was analyzed using the log-rank test. Results: In total, 968 patients were included in the study. The median age was 68 years (range 0–95), 62% of patients were males, and 62.5% (n = 605) were treated with chemotherapy. The median OS for <18, 18–49, 50–64, 65–79 and 80+ age groups was 69, 18, 8, 3 and 1 month, respectively (p < 0.0001). Patients who received chemotherapy had significantly improved OS compared to patients who did not, among both adults (p < 0.0001) and children (p = 0.004). There were no significant differences in OS based on sex, race, ethnicity and median household income. Median OS for adults diagnosed in 2000–2004, 2005–2009, 2010–2014, 2015–2019 was 4, 6, 6 and 3 months, respectively, with no significant differences in OS between these groups. Conclusion: AEL occurs in all age groups but is most common in the elderly. Outcomes are poor with current chemotherapeutic agents, with no improvement in the last two decades. This study stresses the urgent need for investigational agents.

NGS panel enhance precise diagnosis of myeloid neoplasms under WHO-HAEM5 and International Consensus Classification: An observational study

“…However, this classification appears to lack uniqueness, as the clinical features of TP53 -mutated AML are much broader than the pure erythroid leukemia, which are more homogeneous. [ 15 ]…”

Acute Erythroid Leukemia: From Molecular Biology to Clinical Outcomes

“…Additionally, a recent study showed that de novo AEL is associated with a better median survival (3.9 months) compared to patients with a history of MDS (2.6 months) or therapy-related AEL (2.3 months) [ 14 ]. The study notes that secondary AEL is characterized by a high incidence of refractory disease and early resistance to the current standard treatments, thereby leading to worse outcomes [ 15 ]. It should be highlighted that these conclusions are almost exclusively based on the former WHO/ICC categories.…”

“…Treatment with chemotherapy and younger age have also been associated with significantly higher overall survival in AEL [ 3 , 15 ]. A recent 2023 retrospective analysis by Gera et al demonstrated an inverse relationship between age and OS in patients with AEL, with a median OS of 69, 18, 8, 3, and 1 month for age groups <18, 18–49, 50–64, 65–79, and 80+, respectively [ 15 ]. Pediatric AEL shows a distinct genomic profile, which could partially explain the more favorable outcomes in this age group [ 15 ].…”

“…A recent 2023 retrospective analysis by Gera et al demonstrated an inverse relationship between age and OS in patients with AEL, with a median OS of 69, 18, 8, 3, and 1 month for age groups <18, 18–49, 50–64, 65–79, and 80+, respectively [ 15 ]. Pediatric AEL shows a distinct genomic profile, which could partially explain the more favorable outcomes in this age group [ 15 ]. Additionally, in many hematologic malignancies, the pediatric chemotherapy regimen is more aggressive, as children are better able to tolerate this treatment compared to adults [ 19 ].…”

“…While the effect of chemotherapy is heightened amongst pediatric patients, the use of chemotherapy appears to be associated with increased survival in both pediatric and adult populations. The OS in this study was 152 vs. 2 months in children who received chemotherapy vs. those who did not, and the OS was 8 vs. 1 month in adults receiving chemotherapy vs. not [ 15 ]. It should be noted that the retrospective nature of these analyses mitigates the significance of these conclusions.…”