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Jagurinoski M, Davidkova Y, Stojcov-Jagurinoska M, Balatzenko G, Spassov B, Guenova M. Secondary acute myeloid leukemia and de novo acute myeloid leukemia with myelodysplasia-related changes - close or complete strangers? Folia Med (Plovdiv) 2023; 65:728-736. [PMID: 38351754 DOI: 10.3897/folmed.65.e98404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/14/2023] [Indexed: 02/16/2024] Open
Abstract
AIM To compare the main features of patients with secondary acute myeloid leukemias (AMLs) after post-myelodysplastic syndrome (AML-post-MDS) or post-myeloproliferative neoplasms (AML-post-MPN) and myeloid blast crisis of chronic myeloid leukemia (CML-BC) vs. de novoAMLs with myelodysplastic characteristics (dn-AML-MDS).
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Affiliation(s)
- Milan Jagurinoski
- National Specialized Hospital for Active Treatment of Hematological Diseases, Sofia, Bulgaria
| | - Yanitsa Davidkova
- National Specialized Hospital for Active Treatment of Hematological Diseases, Sofia, Bulgaria
| | | | - Gueorgui Balatzenko
- National Specialized Hospital for Active Treatment of Hematological Diseases, Sofia, Bulgaria
| | - Branimir Spassov
- National Specialized Hospital for Active Treatment of Hematological Diseases, Sofia, Bulgaria
| | - Margarita Guenova
- National Specialized Hospital for Active Treatment of Hematological Diseases, Sofia, Bulgaria
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2
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Wang X, Ding D, Liu Y. Acute myeloid leukemia secondary to acute B lymphoblastic leukemia treated with maintenance therapy in a child: A case report. Cancer Rep (Hoboken) 2022; 5:e1717. [PMID: 36164709 PMCID: PMC9675377 DOI: 10.1002/cnr2.1717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/06/2022] [Accepted: 09/07/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) has the highest incidence among childhood hematologic cancers. Exposure to certain cytotoxic therapies for ALL is correlated with a higher risk of secondary malignancies. CASE We report a rare case of a 6-year-old girl being diagnosed with secondary acute myeloid leukemia (AML) during her maintenance phase of treatment for ALL with TEL-AML1 fusion gene, approximately 17 months after the primary diagnosis. CONCLUSION This case indicates that we should recognize the increased risk of secondary AML for pediatric ALL patients with TEL-AML1 fusion gene if multiple alkylating drugs and inhibitors for topoisomerase II are included in induction chemotherapy.
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Affiliation(s)
- Xiaoning Wang
- Department of HematologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anPeople's Republic of China
| | - Ding Ding
- Department of PediatricThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anPeople's Republic of China
| | - Yalin Liu
- Department of HematologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anPeople's Republic of China
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Molina A, Xiao L, Ostrom QT, Rosas LG, Greenberg PL. Epidemiologic evaluation of clinical outcomes in ethnic minorities with myelodysplastic syndromes. Leuk Res 2022; 119:106907. [PMID: 35772318 DOI: 10.1016/j.leukres.2022.106907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/21/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
Abstract
Since race/ethnicity and socioeconomic status (SES), including economic and educational disadvantage (EED), may impact overall survival (OS) in primary myelodysplastic syndromes (MDS), we analyzed the impact of these characteristics on OS in Non-Hispanic White (NHW), Non-Hispanic Black (NHB) and Hispanic patients. In this retrospective review using the SEER US population and American Community Survey data between 2001 and 2016, factor analysis was used for 23 county-level SES indicators to identify groups of interrelated measures of EED. For the 52,739 patients identified, increased age at diagnosis, male sex, higher prognostic risk category and higher EED were all associated with reduced OS. The most prominent SES factor extracted by factor analysis was EED. NHB patients had the highest OS compared to NHW and Hispanics. For all patients, EED analysis showed lower OS for most compared to least disadvantaged, most notably in lower-risk disease and Hispanics. More NHB and Hispanics (51% and 49%) were in the most disadvantaged category compared with NHW (30%). No significant differences were noted for causes of death by race/ethnicity. In conclusion, these data indicate that in addition to standard clinical measures for analyzing OS, race/ethnicity, SES and EED are critical determinants for assessing clinical outcomes in MDS patients.
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Affiliation(s)
- Alfonso Molina
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Lan Xiao
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, United States of America
| | - Quinn T Ostrom
- Department of Neurosurgery and Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, United States of America
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, United States of America
| | - Peter L Greenberg
- Stanford Cancer Institute, Division of Hematology, Stanford University School of Medicine, Stanford, CA, United States of America.
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Servais S, Beguin Y, Baron F. OUP accepted manuscript. Stem Cells Transl Med 2022; 11:461-477. [PMID: 35438781 PMCID: PMC9154332 DOI: 10.1093/stcltm/szac015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/25/2022] [Indexed: 11/12/2022] Open
Abstract
As in younger patients, allogeneic stem cell transplantation (alloHSCT) offers the best chance for durable remission in older patients (≥60 years) with acute myeloid leukemia (AML). However, defining the best treatment strategy (and in particular, whether or not to proceed to alloHSCT) for elderly patients with AML remains a difficult decision for the hematologist, since potential toxicity of conditioning regimens, risks of graft-versus-host disease, impaired immune reconstitution and the need for prolonged immunosuppression may be of major concern in these vulnerable patients with complex needs. Hopefully, significant progress has been made over the past decade in alloHSCT for elderly patients and current evidence suggests that chronological age per se (between 60 and 75) is not a reliable predictor of outcome after alloHSCT. Here, we review the current state of alloHSCT in elderly patients with AML and also discuss the different approaches currently being investigated to improve both accessibility to as well as success of alloHSCT in these patients.
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Affiliation(s)
- Sophie Servais
- Department of Clinical Hematology, CHU of Liège, Liège, Belgium
- Hematology Research Unit GIGA-I3, University of Liège, Liège, Belgium
| | - Yves Beguin
- Department of Clinical Hematology, CHU of Liège, Liège, Belgium
- Hematology Research Unit GIGA-I3, University of Liège, Liège, Belgium
| | - Frédéric Baron
- Corresponding author: Baron Frédéric, Clinical Hematology Department, University of Liège, CHU of Liège (Sart-Tilman), 4000 Liège, Belgium. Tel: +32 4 366 72 01;
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Prognostic Markers of Myelodysplastic Syndromes. ACTA ACUST UNITED AC 2020; 56:medicina56080376. [PMID: 32727068 PMCID: PMC7466347 DOI: 10.3390/medicina56080376] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 12/26/2022]
Abstract
Myelodysplastic syndrome (MDS) is a clonal disease characterized by multilineage dysplasia, peripheral blood cytopenias, and a high risk of transformation to acute myeloid leukemia. In theory, from clonal hematopoiesis of indeterminate potential to hematologic malignancies, there is a complex interplay between genetic and epigenetic factors, including miRNA. In practice, karyotype analysis assigns patients to different prognostic groups, and mutations are often associated with a particular disease phenotype. Among myeloproliferative disorders, secondary MDS is a group of special entities with a typical spectrum of genetic mutations and cytogenetic rearrangements resembling those in de novo MDS. This overview analyzes the present prognostic systems of MDS and the most recent efforts in the search for genetic and epigenetic markers for the diagnosis and prognosis of MDS.
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Ferrara F, Picardi A. Is outcome of older people with acute myeloid leukemia improving with new therapeutic approaches and stem cell transplantation? Expert Rev Hematol 2020; 13:99-108. [PMID: 31922453 DOI: 10.1080/17474086.2020.1715207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: The clinical outcome of older patients with acute myeloid leukemia (AML) is still poor, especially for those who are unfit to treatments aimed at altering the natural course of the disease. Hypomethylating agents (HMA) offer an important therapeutic opportunity to a consistent number of patients, but long-term results are largely unsatisfactory.Area covered: Recently, a number of new agents have been registered for AML, some of which selectively available for older patient population, with promising results in terms of response rate and survival. Furthermore, the upper age limit for allogeneic stem cell transplantation is constantly increasing, so that this procedure is offered and actually given to an increasing number of older patients with AML. A literature review was conducted of the PubMed database for articles published in English as well as for abstracts from most important and recent hematology meetings on AML in older patients.Expert opinion: Appropriate selection among different options on the basis of clinical fitness and molecular findings at diagnosis as well as at relapse would result in improvement of therapeutic results, sparing unnecessary toxicity and optimizing health systems resources.
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Affiliation(s)
- Felicetto Ferrara
- Division of Hematology and Stem Cell Transplantation Program, AORN Cardarelli Hospital, Naples, Italy
| | - Alessandra Picardi
- Division of Hematology and Stem Cell Transplantation Program, AORN Cardarelli Hospital, Naples, Italy.,Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
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Is There Still a Role for Autologous Stem Cell Transplantation for the Treatment of Acute Myeloid Leukemia? Cancers (Basel) 2019; 12:cancers12010059. [PMID: 31878297 PMCID: PMC7016672 DOI: 10.3390/cancers12010059] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 12/12/2022] Open
Abstract
After intensive induction chemotherapy and complete remission achievement, patients with acute myeloid leukemia (AML) are candidates to receive either high-dose cytarabine-based regimens, or autologous (ASCT) or allogeneic (allo-SCT) hematopoietic stem cell transplantations as consolidation treatment. Pretreatment risk classification represents a determinant key of type and intensity of post-remission therapy. Current evidence indicates that allo-SCT represents the treatment of choice for high and intermediate risk patients if clinically eligible, and its use is favored by increasing availability of unrelated or haploidentical donors. On the contrary, the adoption of ASCT is progressively declining, although numerous studies indicate that in favorable risk AML the relapse rate is lower after ASCT than chemotherapy. In addition, the burden of supportive therapy and hospitalization favors ASCT. In this review, we summarize current indications (if any) to ASCT on the basis of molecular genetics at diagnosis and minimal residual disease evaluation after induction/consolidation phase. Finally, we critically discuss the role of ASCT in older patients with AML and acute promyelocytic leukemia.
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Ye X, Chen D, Zheng Y, Wu C, Zhu X, Huang J. The incidence, risk factors, and survival of acute myeloid leukemia secondary to myelodysplastic syndrome: A population-based study. Hematol Oncol 2019; 37:438-446. [PMID: 31378958 PMCID: PMC6900108 DOI: 10.1002/hon.2660] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/11/2019] [Accepted: 07/26/2019] [Indexed: 12/19/2022]
Abstract
To determine the incidence, risk factors, and relative survival of acute myeloid leukemia (AML) secondary to myelodysplastic syndrome (MDS) in the Surveillance, Epidemiology, and End Results (SEER) database. Retrospective analysis of all patients with new MDS onset in the SEER‐18 database from 2001 to 2013. We identified 36 558 patients with primary MDS. The rate of secondary AML (sAML) was 3.7% among patients 40 years or younger and 2.5% among those older than 40 (P = .039). The median transformation interval was significantly shorter for the younger group (4.04 vs 13.1 mo; P < .001). For both age groups, median overall and cancer‐specific survival were significantly longer for patients who did not develop sAML. Although the younger patients survived longer than the older patients, sAML development had a more negative effect on the survival of younger patients. Female sex, age, and World Health Organization (WHO) type MDS with single lineage dysplasia (MDS‐SLD) were associated with a decreased risk of sAML for older but not younger patients. Among older patients with MDS, a married status, Black race, female sex, shorter time to sAML, and WHO type MDS‐SLD or MDS with ringed sideroblasts were favorable prognostic factors for survival. In the SEER database, the rate of sAML among patients with MDS is lower than that in previous reports, but these patients still have worse survival. Risk assessment should include clinical and demographic factors.
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Affiliation(s)
- Xingnong Ye
- Department of Hematology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Dan Chen
- Department of Hematology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yan Zheng
- Department of Hematology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Cai Wu
- Department of Hematology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Xiaoqiong Zhu
- Department of Hematology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jian Huang
- Department of Hematology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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