Treatment patterns and outcomes of 2310 patients with secondary acute myeloid leukemia: a PETHEMA registry study

Secondary acute myeloid leukemia (sAML) comprises a heterogeneous group of patients, and is associated with poor overall survival (OS). Weanalyzethe characteristics, treatment patterns and outcomes of sAML adult patients of the Programa Español de Tratamientos en Hematología (PETHEMA) registry. Overall, 6211 (72.9%) were de novoand 2310 (27.1%) sAML, divided into myelodysplastic syndrome(MDS-AML, 44%), MDS/myeloproliferative (MDS/MPN-AML, 10%), MPN-AML(11%), therapy-related (t-AML, 25%), and antecedent neoplasia without prior chemotherapy/radiotherapy (neo-AML, 9%). Compared to de novo, sAMLwere older (median age 69 years old), had more ECOG ≥2 (35%)or high-risk cytogenetics (40%), less FLT3-ITD (11%) and NPM1mutations (21%), andreceived less intensive chemotherapy regimens (38%) (all P<0.001).Median OS was higher in de novothan in sAML (10.9 vs 5.6 months, P<0.001); and shorterin sAML after hematologic disorder (MDS, MDS/MPN or MPN) as compared to t-AML and neo-AML (5.3 vs 6.1 vs 5.7 months, respectively, P=0.04).After intensive chemotherapy, median OS was better among de novoand neo-AML patients (17.2 and 14.6 months). No OS differences were observed afterhypomethylating agentsaccording to type of AML. sAML was as an independent adverse prognostic factor for OS. Weconfirmhigh prevalence and adverse features of sAML and we establish its independent adverse prognostic value.This study was registered at www.clinicaltrials.gov as #NCT02607059.