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Acute myeloid leukemia with myelodysplasia-related changes diagnosed with multilineage dysplasia alone demonstrates a superior clinical outcome.
- Source :
-
Human pathology [Hum Pathol] 2020 Oct; Vol. 104, pp. 117-126. Date of Electronic Publication: 2020 Aug 13. - Publication Year :
- 2020
-
Abstract
- Acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) generally confers poor prognosis; however, the clinical outcome remains heterogeneous. We sought to further stratify this subentity of AML by performing a retrospective analysis of 179 adult patients with AML-MRC diagnosed at our institution. Based on 2016 World Health Organization diagnostic criteria, 44 (25%) patients had multilineage dysplasia alone (AML-MRC-M), 74 (41%) had history of myelodysplastic syndrome (MDS) or myelodysplastic/myeloproliferative disease (AML-MRC-H), and 61 (34%) had MDS-related cytogenetics (AML-MRC-C). AML-MRC-M and hematopoietic stem cell transplantation (HSCT) were associated with prolonged event-free survival (EFS) (P = 0.0051 and P < 0.0001, respectively) and overall survival (OS) (P = 0.0015 and P < 0.0001, respectively), whereas AML-MRC-C and age ≥60 years were associated with shorter EFS (P = 0.028 and P = 0.015, respectively) and OS (P = 0.021 and P = 0.013, respectively). Of note, NPM1 <superscript>mut</superscript> did not affect the patient's outcome. Multivariable analysis confirmed HSCT and AML-MRC-C as independent predictors for EFS (P < 0.0001 and P = 0.0342, respectively) and OS (P < 0.0001 and P = 0.0295, respectively). AML-MRC-M was an independent predictor for OS (P = 0.0449). When compared with a control group of 105 patients with normal karyotype AML not otherwise specified (NK-AML-NOS), patients with AML-MRC-M had similar EFS and OS (P = 0.99 and P = 0.91, respectively). However, AML-MRC-H and AML-MRC-C were associated with shorter EFS and OS (P = 0.0002 and P < 0.0001, respectively) than the same control group. In a subset of patients, next-generation sequencing analysis showed AML-MRC-M was associated with ASXL1 mutation compared with NK-AML (56% vs 6%). In conclusion, AML-MRC-M demonstrates a superior clinical outcome compared with the rest of the AML-MRC group. They have comparable outcomes to NK-AML-NOS, and these data suggest AML-MRC-M may be considered not to be classified in the same group as patients with other AML-MRC.<br /> (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Aged
Aged, 80 and over
Biomarkers, Tumor genetics
Cell Lineage
Female
Genetic Predisposition to Disease
Humans
Leukemia, Myeloid, Acute genetics
Leukemia, Myeloid, Acute mortality
Leukemia, Myeloid, Acute pathology
Male
Middle Aged
Mutation
Myelodysplastic Syndromes genetics
Myelodysplastic Syndromes mortality
Myelodysplastic Syndromes pathology
Nuclear Proteins genetics
Nucleophosmin
Progression-Free Survival
Repressor Proteins genetics
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Young Adult
Hematopoietic Stem Cell Transplantation adverse effects
Hematopoietic Stem Cell Transplantation mortality
Leukemia, Myeloid, Acute surgery
Myelodysplastic Syndromes surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1532-8392
- Volume :
- 104
- Database :
- MEDLINE
- Journal :
- Human pathology
- Publication Type :
- Academic Journal
- Accession number :
- 32798550
- Full Text :
- https://doi.org/10.1016/j.humpath.2020.08.003