Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jul 19;1(17):1312-1323.
doi: 10.1182/bloodadvances.2017008227. eCollection 2017 Jul 25.

Treated secondary acute myeloid leukemia: a distinct high-risk subset of AML with adverse prognosis

Prajwal Boddu  1 , Hagop M Kantarjian  1 , Guillermo Garcia-Manero  1 , Farhad Ravandi  1 , Srdan Verstovsek  1 , Elias Jabbour  1 , Gautam Borthakur  1 , Marina Konopleva  1 , Kapil N Bhalla  1 , Naval Daver  1 , Courtney D DiNardo  1 , Christopher B Benton  1 , Koichi Takahashi  1 , Zeev Estrov  1 , Sherry R Pierce  1 , Michael Andreeff  1 , Jorge E Cortes  1 , Tapan M Kadia  1
Affiliations

Treated secondary acute myeloid leukemia: a distinct high-risk subset of AML with adverse prognosis

Prajwal Boddu et al. Blood Adv. .

Abstract

Secondary acute myeloid leukemia (s-AML) includes therapy-related AML and AML evolving from antecedent hematological disorder (AHD). s-AML arising after treating AHD likely represents a prognostically distinct, high-risk disease category. In this study, treated s-AML (ts-AML) was defined by: (1) prior diagnosis of myelodysplasia, myeloproliferative neoplasm, or aplastic anemia and (2) at least 1 therapy for that diagnosis. ts-AML was categorized by age (< or ≥60 years), and each cohort assessed for response rates and overall survival (OS) on various treatment regimens. Survival outcomes were compared against other high-risk prognostic subsets. Results showed that complete response and 8-week mortality rates were 32% and 27% in the younger, and 24% and 19% in the older age groups, respectively. There was a significant OS difference within s-AML based on prior treatment of AHD (ie, ts-AML vs s-AML with untreated AHD, 4.2 vs 9.2 months; P < .001). Survival in ts-AML was poor across both cohorts (younger and older, 5 and 4.7 months, respectively). In younger AML, survival was significantly inferior in ts-AML when compared with deletion 5/7, TP53, 3q abnormality, and therapy-related AML groups (median, 5 vs 7.9, 7.8, 7.9, and 11.2 months, respectively; P < .01). Additional adverse karyotype within ts-AML was associated with even worse outcomes (OS range, 1.6-2.8 months). ts-AML represents a very high-risk category, even in younger AML patients. s-AML should be further classified to describe ts-AML, an entity less responsive to currently applied treatment approaches. Future AML trial designs should accommodate ts-AML as a distinct subgroup.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Younger AML. OS comparisons between the (A) ts-AML and non–ts-AML population, (B) various prognostic risk groups including ts-AML, (C) ts-AML and t-AML, and (D) ts-AML based on whether patients had undergone transplant. chr, chromosome; SCT, allogeneic stem cell transplant; tot, total.
Figure 2.
Figure 2.
Younger AML cohort. OS with ts-AML based on associated presence of (A) monosomy 5/7 and (B) 3q abnormality.
Figure 3.
Figure 3.
OS within younger ts-AML by different induction regimens. INT, intermediate intensity regimen; INV, low-intensity/investigational regimens; m, months.
Figure 4.
Figure 4.
Older AML. OS comparisons between (A) ts-AML and non–ts-AML population, (B) various prognostic risk groups including ts-AML, (C) ts-AML and t-AML, and (D) ts-AML based on whether patients had undergone transplant.
Figure 5.
Figure 5.
Younger AML cohort OS. ts-AML OS based on associated presence of (A) monosomy 5/7 and (B) 3q abnormality.
Figure 6.
Figure 6.
OS within older ts-AML by different induction regimens.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Bennett JM. Secondary acute myeloid leukemia. Leuk Res. 1995;19(4):231-232. - PubMed
    1. Larson RA. Is secondary leukemia an independent poor prognostic factor in acute myeloid leukemia? Best Pract Res Clin Haematol. 2007;20(1):29-37. - PubMed
    1. Granfeldt Østgård LS, Medeiros BC, Sengeløv H, et al. . Epidemiology and clinical significance of secondary and therapy-related acute myeloid leukemia: a national population-based cohort study. J Clin Oncol. 2015;33(31):3641-3649. - PubMed
    1. Campo E, Swerdlow SH, Harris NL, Pileri S, Stein H, Jaffe ES. The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications. Blood. 2011;117(19):5019-5032. - PMC - PubMed
    1. Weinberg OK, Seetharam M, Ren L, et al. . Clinical characterization of acute myeloid leukemia with myelodysplasia-related changes as defined by the 2008 WHO classification system. Blood. 2009;113(9):1906-1908. - PubMed