Characteristics and outcomes of patients with therapy-related acute myeloid leukemia with normal karyotype.
Bachar SamraGuillaume Richard-CarpentierTapan M KadiaFarhad RavandiNaval DaverCourtney D D DiNardoGhayas C IssaPrithviraj BoseMarina Y KonoplevaMusa YilmazMaro OhanianGautam BorthakurGuillermo Garcia-ManeroSherry PierceJorge E CortesHagop KantarjianNicholas J ShortPublished in: Blood cancer journal (2020)
Normal karyotype in therapy-related acute myeloid leukemia (t-AML) is rare and the relative contribution of prior exposure to chemotherapy or radiotherapy to outcomes in these patients remains uncertain. We performed a retrospective study of 742 patients with newly diagnosed AML and normal karyotype (t-AML, n = 61, and non-t-AML, n = 681). Patients with t-AML were older but had a similar mutational profile compared to those with non-t-AML. Overall survival (OS) and relapse-free survival (RFS) were significantly worse for patients with t-AML (P < 0.01 and P = 0.02, respectively). Patients with t-AML had a higher cumulative incidence of death in remission (51% versus 16%, P < 0.01), but not higher cumulative incidence of relapse (42% versus 56%, respectively, P = 0.21). Both intensive induction and allogeneic hematopoietic stem cell transplantation in first remission were associated with improved OS and RFS in non-t-AML but not in t-AML. Overall, although disease biology appears similar between t-AML and non-t-AML with normal karyotype as indicated by similar risks of relapse, death in remission is the main driver of inferior outcome in t-AML. Careful therapeutic decisions are required to mitigate potential treatment-related toxicity in this rare subgroup of patients with t-AML and normal karyotype.
Keyphrases
- acute myeloid leukemia
- allogeneic hematopoietic stem cell transplantation
- newly diagnosed
- free survival
- acute lymphoblastic leukemia
- early stage
- risk factors
- stem cells
- oxidative stress
- randomized controlled trial
- type diabetes
- rheumatoid arthritis
- insulin resistance
- risk assessment
- chronic kidney disease
- physical activity
- squamous cell carcinoma
- clinical trial
- study protocol
- weight loss
- combination therapy
- double blind