Clinical outcomes of therapy-related acute myeloid leukemia: an over 20-year single-center retrospective analysis.

INTRODUCTION

Therapy‑related acute myeloid leukemia (t‑AML), a life‑threatening complication of cytotoxic therapy, represents an emerging challenge of modern oncology.

OBJECTIVES

We aimed to evaluate clinical outcomes of patients with t‑AML, taking into consideration genetic changes and treatment intensity.

PATIENTS AND METHODS

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.

RESULTS

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.

CONCLUSIONS

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.