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

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

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22 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1312-1323
Number of pages12
JournalBlood Advances
Volume1
Issue number17
DOIs
StatePublished - Jul 25 2017
Externally publishedYes

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ASJC Scopus subject areas

  • Hematology

Cite this

Boddu, P., Kantarjian, H. M., Garcia-Manero, G., Ravandi, F., Verstovsek, S., Jabbour, E., Borthakur, G., Konopleva, M., Bhalla, K. N., Daver, N., DiNardo, C. D., Benton, C. B., Takahashi, K., Estrov, Z., Pierce, S. R., Andreeff, M., Cortes, J. E., & Kadia, T. M. (2017). Treated secondary acute myeloid leukemia: A distinct high-risk subset of AML with adverse prognosis. Blood Advances, 1(17), 1312-1323. https://doi.org/10.1182/bloodadvances.2017008227