Interactions and relevance of blast percentage and treatment strategy among younger and older patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS)

Courtney D. Dinardo, Guillermo Garcia-Manero, Sherry Pierce, Aziz Nazha, Carlos Bueso-Ramos, Elias Jabbour, Farhad Ravandi, Jorge Cortes, Hagop Kantarjian

Research output: Contribution to journalArticle

Abstract

Acute myeloid leukemia (AML) is defined as ≥20% myeloblasts, representing a change from original guidelines where ≤30% blasts were considered as myelodysplastic syndromes (MDS), and 20-29% blasts classified as refractory anemia with excess blasts in transformation (RAEB-T). Whether the diagnostic bone marrow blast percentage has current value with regards to patient prognostication or identification of optimal treatment strategies is unclear. We retrospectively studied 1652 treatment-naïve adults with MDS or AML and ≥10% blasts from January 2000 to April 2014. Patients with 20-29% blasts were more similar to MDS patients in terms of advanced age, increased frequency of poor-risk cytogenetics, lower WBC count, and less frequent NPM1 and FLT3-ITD mutations. Median overall survival of MDS and RAEB-T were similar, 16.0 and 16.0 months, compared to 13.5 months for AML with ≥30% blasts (P=0.045). Multivariate analysis showed inferior survival with increased age (HR 1.81 age 60-69, HR 2.68 age ≥70, P<0.0005); poor-risk cytogenetics (HR 2.25, P<0.0005); therapy-related disease (HR 1.44, P<0.0005); and markers of proliferative disease including WBC ≥25 × 109/L (HR 1.35, P = 0.0003), elevated LDH count (HR 1.24, P=0.0015), and peripheral blasts (HR 1.25, P=0.004). Among younger patients (≤60 years), intensive AML-type therapy resulted in similar outcomes regardless of blast percentage, suggesting this to be optimal therapy in this context. Among older patients (≥70 years), patients with 20-29% blasts had similar outcomes to patients with <20% blasts, and better than those with ≥30% blasts. In addition, among older patients, epigenetic therapy provided at least equivalent outcome to intensive chemotherapy.

Original languageEnglish (US)
Pages (from-to)227-232
Number of pages6
JournalAmerican Journal of Hematology
Volume91
Issue number2
DOIs
StatePublished - Feb 1 2016
Externally publishedYes

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Myelodysplastic Syndromes
Acute Myeloid Leukemia
Refractory Anemia with Excess of Blasts
Therapeutics
Lymphocyte Activation
Cytogenetics
Granulocyte Precursor Cells
Survival
Epigenomics
Multivariate Analysis
Bone Marrow
Guidelines
Drug Therapy
Mutation

ASJC Scopus subject areas

  • Hematology

Cite this

Interactions and relevance of blast percentage and treatment strategy among younger and older patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). / Dinardo, Courtney D.; Garcia-Manero, Guillermo; Pierce, Sherry; Nazha, Aziz; Bueso-Ramos, Carlos; Jabbour, Elias; Ravandi, Farhad; Cortes, Jorge; Kantarjian, Hagop.

In: American Journal of Hematology, Vol. 91, No. 2, 01.02.2016, p. 227-232.

Research output: Contribution to journalArticle

Dinardo, Courtney D. ; Garcia-Manero, Guillermo ; Pierce, Sherry ; Nazha, Aziz ; Bueso-Ramos, Carlos ; Jabbour, Elias ; Ravandi, Farhad ; Cortes, Jorge ; Kantarjian, Hagop. / Interactions and relevance of blast percentage and treatment strategy among younger and older patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). In: American Journal of Hematology. 2016 ; Vol. 91, No. 2. pp. 227-232.
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AU - Pierce, Sherry

AU - Nazha, Aziz

AU - Bueso-Ramos, Carlos

AU - Jabbour, Elias

AU - Ravandi, Farhad

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