Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznań, Poland; Doctoral School, Poznan University of Medical Sciences, Poznań, Poland.
Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznań, Poland
Pol Arch Intern Med. 2023 Jan 24;133(1). doi: 10.20452/pamw.16344. Epub 2022 Sep 27.
Therapy‑related acute myeloid leukemia (t‑AML), a life‑threatening complication of cytotoxic therapy, represents an emerging challenge of modern oncology.
We aimed to evaluate clinical outcomes of patients with t‑AML, taking into consideration genetic changes and treatment intensity.
We conducted a retrospective analysis of all consecutive AML patients from a single hematology center (hospitalized between 2000 and 2021). The diagnosis of t‑AML was established according to the 2016 World Health Organization criteria. Overall survival (OS) and progression‑free survival (PFS) were used to evaluate treatment outcomes. Retrospective identification of 17p13 deletion and TP53 mutation was conducted.
Among 743 patients with AML, 60 (8.1%) were diagnosed with t‑AML (63.4% had previous solid tumors). A complex karyotype (CK) and 17p13 deletion were detected in 26.8% and 26.7% of the t‑AML cases, respectively, while FLT3‑ITD and TP53 mutations occurred in 15.4% and 12.5% of the patients with t‑AML, respectively. Median OS and PFS were 13 and 8 months, respectively. The survival outcomes were superior in the patients who underwent an allogenic hematopoietic cell transplantation (alloHCT) than in those treated with intensive chemotherapy alone (median OS, 47 vs 7 months, respectively; P = 0.01). Patients with therapy‑related acute promyelocytic leukemia did not reach the median OS, and worse survival was noted in CK than non‑CK t‑AML (median OS, 6 vs 24 months; P = 0.02). In intensively treated t‑AML, the survival was better for the patients younger than 64 years (P = 0.03). In the multivariable Cox proportional hazards regression model, alloHCT was associated with longer OS (hazard ratio, 0.19; 95% CI, 0.04-0.91; P = 0.04). Moreover, we noted a high frequency of treatment‑related complications of t‑AML.
Our study revealed that prognosis of t‑AML varies. Hence, the treatment strategy should include performing alloHCT as soon as possible in the patients with an adverse genetic profile.
治疗相关的急性髓系白血病（t-AML）是细胞毒性治疗的一种危及生命的并发症，是现代肿瘤学面临的一个新挑战。
我们旨在评估 t-AML 患者的临床结局，同时考虑遗传改变和治疗强度。
我们对单中心血液科（2000 年至 2021 年住院）所有连续 AML 患者进行了回顾性分析。根据 2016 年世界卫生组织标准诊断 t-AML。总生存（OS）和无进展生存（PFS）用于评估治疗结果。回顾性识别 17p13 缺失和 TP53 突变。
在 743 例 AML 患者中，60 例（8.1%）诊断为 t-AML（63.4%有既往实体瘤）。26.8%的 t-AML 病例存在复杂核型（CK），26.7%的 t-AML 病例存在 17p13 缺失，15.4%的 t-AML 患者存在 FLT3-ITD，12.5%的 t-AML 患者存在 TP53 突变。中位 OS 和 PFS 分别为 13 个月和 8 个月。与单独接受强化化疗的患者相比，接受异基因造血细胞移植（alloHCT）的患者生存结局更好（中位 OS，47 个月与 7 个月，P = 0.01）。t-AML 中治疗相关的急性早幼粒细胞白血病患者未达到中位 OS，CK 患者的生存状况较非 CK t-AML 患者更差（中位 OS，6 个月与 24 个月，P = 0.02）。在强化治疗的 t-AML 中，年龄小于 64 岁的患者生存状况更好（P = 0.03）。在多变量 Cox 比例风险回归模型中，alloHCT 与更长的 OS 相关（风险比，0.19；95%CI，0.04-0.91；P = 0.04）。此外，我们还发现 t-AML 相关治疗并发症的发生率较高。
本研究表明 t-AML 的预后存在差异。因此，对于遗传不良的患者，治疗策略应包括尽快进行 alloHCT。
