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Wanitpongpun C, Utchariyaprasit E, Owattanapanich W, Tantiworawit A, Rattarittamrong E, Niparuck P, Puavilai T, Julamanee J, Saelue P, Chanswangphuwana C, Polprasert C, Nakhakes C, Limvorapitak W, Kanitsap N, Prayongratana K, Sriswasdi C. Types, Clinical Features, and Survival Outcomes of Patients with Acute Myeloid Leukemia in Thailand: A 3-Year Prospective Multicenter Study from the Thai Acute Leukemia Study Group (TALSG). CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:e635-e643. [PMID: 33926829 DOI: 10.1016/j.clml.2021.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Acute myeloid leukemia (AML) is a common, challenging hematologic malignancy worldwide. Thai data on its characteristics and outcomes have never been systematically reported, to our knowledge. The objective of this study was to determine the clinical features and outcomes of Thai patients with AML. PATIENTS AND METHODS This was a prospective observational study of nine academic hospitals. Patients with newly diagnosed AML were invited to register online. RESULTS A total of 679 patients with AML were included. The presence of circulating peripheral blood blasts was correlated with a high white blood cell count. Acute promyelocytic leukemia (APL) had predominantly lower white blood cell counts and higher proportions without peripheral blood blasts compared with non-APL AML. Disseminated intravascular coagulation was commonly presented in APL (37.7%). Splenomegaly and normal platelet count were more frequently seen in patients with Philadelphia chromosome-positive AML. The median follow-up time for those who survived more than 1 year was 28.0 months. One-year overall survival rates for non-APL AML and APL were 31.9% and 88.2%, respectively; 2-year overall survival rates were 29.6% and 88.2%, respectively. Hematopoietic stem cell transplantation could improve survival in non-APL AML. CONCLUSION APL should be considered despite absence of peripheral blood blast. This study demonstrates poor outcome of Thai AML and more research to improve outcomes are underway. Expanding access to hematopoietic stem cell transplantation should be considered in Thailand.
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Affiliation(s)
- Chinadol Wanitpongpun
- Hematology Unit, Department of Internal Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand.
| | - Eakkapol Utchariyaprasit
- Division of Hematology, Department of Internal Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Weerapat Owattanapanich
- Division of Hematology, Department of Internal Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Adisak Tantiworawit
- Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Pimjai Niparuck
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Teeraya Puavilai
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Pirun Saelue
- Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chantiya Chanswangphuwana
- Department of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Chantana Polprasert
- Department of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Chajchawan Nakhakes
- Division of Hematology, Department of Medicine, Rajavithi Hospital, Bangkok, Thailand
| | - Wasithep Limvorapitak
- Division of Hematology, Department of Internal Medicine, Thammasat University, Pathumthani, Thailand
| | - Nonglak Kanitsap
- Division of Hematology, Department of Internal Medicine, Thammasat University, Pathumthani, Thailand
| | - Kannadit Prayongratana
- Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Chantrapa Sriswasdi
- Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
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Chim CS, Kwong YL. Adverse prognostic impact ofCDKN2Bhyper-methylationin acute promyelocytic leukemia. Leuk Lymphoma 2009; 47:815-25. [PMID: 16753865 DOI: 10.1080/10428190500513827] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The use of all-trans retinoic acid (ATRA) has markedly improved the survival of patients with acute promyelocytic leukemia (APL), making it potentially curable. However, the identification of prognostic markers predictive of durable remission remains an important aspect in risk-adjusted treatment algorithms. High presentation leucocyte count has been found to correlate with inferior disease-free-survival (DFS). However, recent studies have also shown aberrant promoter methylation of the CDKN2B (alias p15) gene to be a negative prognostic factor. Promoter methylation results in the formation of a repressor complex, leading to chromatin compaction and suppression of gene expression and is, therefore, an alternative mechanism of gene inactivation. CDKN2B, a cyclin-dependent kinase inhibitor, is a tumor suppressor gene inhibiting cell cycle progression. The CpG island inside the CDKN2B promoter is hyper-methylated in approximately 50 - 60% of APL patients. CDKN2B methylation correlates negatively with DFS. As methylation-induced inactivation of CDKN2B pre-disposes to unchecked cellular proliferation, CDKN2B hyper-methylation is also associated with high presentation leucocyte count. Multivariate analysis in several studies, however, has shown that the negative prognostic impact of CDKN2B methylation is independent of its association with high leucocyte counts. Therefore, CDKN2B methylation is a potential prognostic factor that may be incorporated into a risk-stratified therapeutic strategy, which aims at achieving a cure with optimal amounts of treatment.
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Affiliation(s)
- Chor-Sang Chim
- Department of Medicine, University of Hong Kong, Hong Kong, PR China
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