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Wang L, Chu X, Wang J, An L, Liu Y, Li L, Xu J. Clinical Characteristics and Optimal Therapy of Acute Myeloid Leukemia with Myelodysplasia-Related Changes: A Retrospective Analysis of a Cohort of Chinese Patients. Turk J Haematol 2021; 38:188-194. [PMID: 33938209 PMCID: PMC8386305 DOI: 10.4274/tjh.galenos.2021.2021.0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective: This study aimed to investigate the clinical characteristics of acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) according to the 2016 World Health Organization classification and the preferred therapy for patients with AML-MRC aged 60-75 years. Materials and Methods: We retrospectively analyzed differences in clinical data among 190 patients with AML-MRC and 667 patients with AML not otherwise specified (AML-NOS). We also compared different therapeutic regimens among patients with AML-MRC aged 60-75 years. Results: Compared with AML-NOS, patients with AML-MRC had significantly different clinical characteristics as well as worse overall survival (OS) (9.2 vs. 13.6 months; p<0.001) and complete remission rates (65.3% vs. 76.2%; p=0.005). Multivariate analysis performed for the whole group (patients with both AML-MRC and AML-NOS) showed that AML-MRC was the independent prognostic factor (p=0.002). Additional multivariate analysis performed for 190 patients with AML-MRC indicated that age (p<0.001) and lactate dehydrogenase (p=0.031) were independent prognostic factors. Compared with the IA/DA regimen [idarubicin and cytarabine (IA) or daunorubicin and cytarabine (DA)], the DAC+CAG regimen [decitabine and half-dose CAG regimen (cytarabine, aclarubicin, and granulocyte colony-stimulating factor)] was associated with better OS (4.5 vs. 6.2 months; p=0.021) in patients aged 60-75 years and categorized into the unfavorable risk group. Conclusion: AML-MRC cases exhibited worse clinical outcomes compared to AML-NOS. Compared to the IA/DA regimen, the DAC+CAG regimen was the optimal choice for patients with AML-MRC in the unfavorable risk group and aged 60-75 years.
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Affiliation(s)
- Lei Wang
- Qingdao University Medical College, Affiliated Yantai Yuhuangding Hospital, Department of Hematology, Yantai, China
| | - Xiaoxia Chu
- Qingdao University Medical College, Affiliated Yantai Yuhuangding Hospital, Department of Hematology, Yantai, China
| | - Jingyao Wang
- Qingdao University Medical College, Affiliated Yantai Yuhuangding Hospital, Department of Hematology, Yantai, China
| | - Licai An
- Qingdao University Medical College, Affiliated Yantai Yuhuangding Hospital, Department of Hematology, Yantai, China
| | - Yinghui Liu
- Qingdao University Medical College, Affiliated Yantai Yuhuangding Hospital, Department of Hematology, Yantai, China
| | - Li Li
- Linyi Central Hospital, Department of Hematology, Linyi, China
| | - Junqing Xu
- Qingdao University Medical College, Affiliated Yantai Yuhuangding Hospital, Department of Hematology, Yantai, China
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Fang H, He R, Chiu A, Viswanatha DS, Ketterling RP, Patnaik MS, Reichard KK. Genetic Factors in Acute Myeloid Leukemia With Myelodysplasia-Related Changes. Am J Clin Pathol 2020; 153:656-663. [PMID: 31977035 DOI: 10.1093/ajcp/aqz206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) is a heterogeneous category with a broad range of underlying genetic abnormalities. We investigated the significance of genetic factors in a large series of AML-MRC cases. METHODS The morphologic findings, genetic data, and patient outcomes were assessed in 186 AML-MRC cases. RESULTS The median overall survival (OS) was dismal in AML-MRC patients (median, 7.6 months; 95% confidence interval, 5-10.6 months). Karyotypically normal cases and cytogenetically abnormal cases without myelodysplastic syndrome (MDS)-related cytogenetic abnormalities showed similar OS, significantly better than cases carrying MDS-related cytogenetic abnormalities. MDS-related cytogenetic abnormalities, monosomal or complex karyotype, and history of MDS or myelodysplastic/myeloproliferative neoplasm were all associated with dismal outcome. CONCLUSIONS AML-MRC predicts a poor prognosis. Our study supports the finding that the genetic profile plays a key role in determining prognosis in AML-MRC as defined according to the World Health Organization revised fourth edition (2017) diagnostic criteria.
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Affiliation(s)
- Hong Fang
- Division of Hematopathology, Rochester, MN
| | - Rong He
- Division of Hematopathology, Rochester, MN
| | - April Chiu
- Division of Hematopathology, Rochester, MN
| | | | - Rhett P Ketterling
- Division of Hematopathology, Rochester, MN
- Division of Laboratory Genetics, Rochester, MN
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Prats-Martín C, Burillo-Sanz S, Morales-Camacho RM, Pérez-López O, Suito M, Vargas MT, Caballero-Velázquez T, Carrillo-Cruz E, González J, Bernal R, Pérez-Simón JA. ASXL1 mutation as a surrogate marker in acute myeloid leukemia with myelodysplasia-related changes and normal karyotype. Cancer Med 2020; 9:3637-3646. [PMID: 32216059 PMCID: PMC7286456 DOI: 10.1002/cam4.2947] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/21/2020] [Accepted: 02/12/2020] [Indexed: 11/06/2022] Open
Abstract
Acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) are poor outcome leukemias. Its diagnosis is based on clinical, cytogenetic, and cytomorphologic criteria, last criterion being sometimes difficult to assess. A high frequency of ASXL1 mutations have been described in this leukemia. We sequenced ASXL1 gene mutations in 61 patients with AML-MRC and 46 controls with acute myeloid leukemia without other specifications (AML-NOS) to identify clinical, cytomorphologic, and cytogenetic characteristics associated with ASXL1 mutational status. Mutated ASXL1 (ASXL1+) was observed in 31% of patients with AML-MRC compared to 4.3% in AML-NOS. Its presence in AML-MRC was associated with older age, a previous history of myelodysplastic syndrome (MDS) or myelodysplastic/myeloproliferative neoplasms (MDS/MPN), leukocytosis, presence of micromegakaryocytes in bone marrow, lower number of blasts in bone marrow, myelomonocytic/monocytic morphological features and normal karyotype. ASXL1 mutation was not observed in patients with myelodysplastic syndrome-related cytogenetic abnormalities or TP53 mutations. Differences in terms of overall survival were found only in AML-MRC patients without prior MDS or MDS/MPN and with intermediate-risk karyotype, having ASXL1+ patients a worst outcome than ASXL1-. We conclude that the ASXL1 mutation frequency is high in AML-MRC patients being its presence associated with specific characteristics including morphological signs of dysplasia. This association raises the possible role of ASXL1 as a surrogate marker in AML-MRC, which could facilitate the diagnosis of patients within this group when the karyotype is normal, and especially when the assessment of multilineage dysplasia morphologically is difficult. This mutation could be used as a worst outcome marker in de novo AML-MRC with intermediate-risk karyotype.
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Affiliation(s)
- Concepción Prats-Martín
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CISC/CIBERONC), Universidad de Sevilla, Sevilla, Spain
| | - Sergio Burillo-Sanz
- Department of Immunology, Hospital Universitario Virgen del Rocío. Sevilla, Sevilla, Spain
| | - Rosario M Morales-Camacho
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CISC/CIBERONC), Universidad de Sevilla, Sevilla, Spain
| | - Olga Pérez-López
- Department of Hematology, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, Spain
| | - Milagros Suito
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CISC/CIBERONC), Universidad de Sevilla, Sevilla, Spain
| | - Maria T Vargas
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CISC/CIBERONC), Universidad de Sevilla, Sevilla, Spain
| | - Teresa Caballero-Velázquez
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CISC/CIBERONC), Universidad de Sevilla, Sevilla, Spain
| | - Estrella Carrillo-Cruz
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CISC/CIBERONC), Universidad de Sevilla, Sevilla, Spain
| | - José González
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CISC/CIBERONC), Universidad de Sevilla, Sevilla, Spain
| | - Ricardo Bernal
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CISC/CIBERONC), Universidad de Sevilla, Sevilla, Spain
| | - José A Pérez-Simón
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CISC/CIBERONC), Universidad de Sevilla, Sevilla, Spain
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Clinicopathological, Cytogenetic, and Prognostic Analysis of 131 Myeloid Sarcoma Patients. Am J Surg Pathol 2016; 40:1473-1483. [DOI: 10.1097/pas.0000000000000727] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Abstract
OBJECTIVES Acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) is a heterogeneous disorder defined by morphologic, genetic, or clinical features. Genetic abnormalities associated with AML-MRC are often associated with adverse prognostic features, and many cases are preceded by a myelodysplastic syndrome (MDS) or a myelodysplastic/myeloproliferative neoplasm. METHODS Although the criteria of 20% or more blasts in blood or bone marrow and multilineage dysplasia affecting 50% or more of cells in two or more of the myeloid lineages seem straightforward for AML-MRC, identification of morphologic dysplasia among observers is not always consistent, and there is morphologic overlap with other leukemic disorders such as acute erythroleukemia. RESULTS Session 3 of the workshop cases displayed heterogeneity as expected within AML-MRC, yet several cases suggested that recently recognized entities may exist within this category, such as familial MDS/AML predisposition syndromes and rare cases of high-risk AML associated with the cryptic t(5;11)(q35;p15);NUP98-NSD1 that may masquerade as a del(5q). However, most cases of AML-MRC were usually associated with adverse genetic abnormalities, particularly -5/del(5q), -7/del(7q), and/or complex karyotypes. CONCLUSIONS Whole-genome sequencing and array studies may identify genetic abnormalities, such as those affecting TP53, which may provide prognostic information.
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Bahl A, Sharma A, Raina V, Kumar L, Bakhshi S, Gupta R, Kumar R. Long-term outcomes for patients with acute myeloid leukemia: a single-center experience from AIIMS, India. Asia Pac J Clin Oncol 2015; 11:242-52. [PMID: 25639656 DOI: 10.1111/ajco.12333] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2014] [Indexed: 11/29/2022]
Abstract
AIM To analyze clinicopathological characteristics of acute myeloid leukemia (AML) patients and to evaluate long-term outcome of these patients presented to single tertiary care center in India. METHODS We evaluated outcomes of 480 patients (age 8-60 years), classified into good, intermediate and poor risk according to cytogenetic results. Standard "3 + 7" induction therapy with dose of daunorubicin ranging from 45 to 90 mg/m(2) followed by two to three courses of high-dose cytarabine (12-18 g/m(2) ) as consolidation therapy was given to majority. RESULTS The complete remission rate of the treated population (407 patients) was 70% with 84.8% in good risk, 67.9% in intermediate risk and 54.2% in poor risk (P = 0.0001). Induction mortality was 18.4%. One hundred twenty-nine patients relapsed with median treatment free interval of 10.4 months. At a median follow-up of 34.5 months, the median overall survival (OS) was 20.6 months with an estimated 5-year survival rate of 35.5%. No difference was found in OS between the three risk groups; however, patients with intermediate risk had a better leukemia-free survival (LFS) in comparison to good risk. Multivariate analysis showed age, performance status, treatment completion and hematopoietic stem cell transplant affecting OS, while only treatment completion affected LFS. CONCLUSION This is one of the largest single-center studies reflecting more accurately the outcome of AML in India. These results are likely due to uniform treatment protocols, intensification of induction and post-remission treatments with comprehensive supportive care.
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Affiliation(s)
- Ankur Bahl
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Raina
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Gupta
- Department of Laboratory Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Laboratory Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Xu XQ, Wang JM, Gao L, Qiu HY, Chen L, Jia L, Hu XX, Yang JM, Ni X, Chen J, Lü SQ, Zhang WP, Song XM. Characteristics of acute myeloid leukemia with myelodysplasia-related changes: A retrospective analysis in a cohort of Chinese patients. Am J Hematol 2014; 89:874-81. [PMID: 24861848 DOI: 10.1002/ajh.23772] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/12/2014] [Accepted: 05/23/2014] [Indexed: 11/09/2022]
Abstract
We retrospectively analyzed 449 patients with AML under the WHO classification of AML 2008 and probed implications of this classification in diagnosis and treatment of acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) among them. The clinical presentations, biological features, treatments, and prognosis of patients diagnosed with AML-MRC were analyzed and compared with those of AML not otherwise specified (AML-NOS). In all patients, 115 (25.6%) were diagnosed as AML-MRC including 64 males and 51 females with median onset age of 48 years (range from 17 to 78). Their complete remission (CR) rate was 60.9% and relapse rate was 57.1%. The observed median overall survival (OS) and disease-free survival (DFS) were 10 and 5 months, respectively, which was significantly shorter than those of AML-NOS patients (P < 0.05). The prognosis of AML-MRC patients with myelodysplastic syndrome (MDS)-related cytogenetics sole was similar to those with history of MDS or myelodysplastic/myeloproliferative neoplasm (MDS/MPN). Patients with MDS-related cytogenetic abnormalities and/or history of MDS or MDS/MPN predisposed significantly shortened CR, OS, and DFS than AML-MRC patients with only multilineage dysplasia (MLD) and AML-NOS patients (P < 0.05). Multivariate analysis showed that age, cytogenetics, and history of MDS or MDS/MPN were independent prognostic factors. Patient diagnosed as AML-MRC presented distinctive clinical and biological features. Presence of MLD does not change the prognosis.
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Affiliation(s)
- Xiao-Qian Xu
- Department of Hematology; Changhai Hospital, Second Military Medical University; Shanghai China
| | - Jian-Min Wang
- Department of Hematology; Changhai Hospital, Second Military Medical University; Shanghai China
| | - Lei Gao
- Department of Hematology; Changhai Hospital, Second Military Medical University; Shanghai China
| | - Hui-Ying Qiu
- Department of Hematology; Changhai Hospital, Second Military Medical University; Shanghai China
| | - Li Chen
- Department of Hematology; Changhai Hospital, Second Military Medical University; Shanghai China
| | - Lin Jia
- Department of Hematology; Changhai Hospital, Second Military Medical University; Shanghai China
| | - Xiao-Xia Hu
- Department of Hematology; Changhai Hospital, Second Military Medical University; Shanghai China
| | - Jian-Min Yang
- Department of Hematology; Changhai Hospital, Second Military Medical University; Shanghai China
| | - Xiong Ni
- Department of Hematology; Changhai Hospital, Second Military Medical University; Shanghai China
| | - Jie Chen
- Department of Hematology; Changhai Hospital, Second Military Medical University; Shanghai China
| | - Shu-Qing Lü
- Department of Hematology; Changhai Hospital, Second Military Medical University; Shanghai China
| | - Wei-Ping Zhang
- Department of Hematology; Changhai Hospital, Second Military Medical University; Shanghai China
| | - Xian-Min Song
- Department of Hematology; Changhai Hospital, Second Military Medical University; Shanghai China
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Kinoshita A, Miyachi H, Matsushita H, Yabe M, Taki T, Watanabe T, Saito AM, Tomizawa D, Taga T, Takahashi H, Matsuo H, Kodama K, Ohki K, Hayashi Y, Tawa A, Horibe K, Adachi S. Acute myeloid leukaemia with myelodysplastic features in children: a report of Japanese Paediatric Leukaemia/Lymphoma Study Group. Br J Haematol 2014; 167:80-6. [PMID: 25039450 DOI: 10.1111/bjh.12993] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 05/20/2014] [Indexed: 11/29/2022]
Abstract
The clinical characteristics and prognostic relevance of acute myeloid leukaemia (AML) with myelodysplastic features remains to be clarified in children. We prospectively examined 443 newly diagnosed patients in a multicentre clinical trial for paediatric de novo AML, and found 'AML with myelodysplasia-related changes' (AML-MRC) according to the 2008 World Health Organization classification in 93 (21·0%), in whom 59 were diagnosed from myelodysplasia-related cytogenetics alone, 28 from multilineage dysplasia alone and six from a combination of both. Compared with 111 patients with 'AML, not otherwise specified' (AML-NOS), patients with 'AML-MRC' presented at a younger age, with a lower white blood cell count, higher incidence of 20-30% bone marrow blasts, unfavourable cytogenetics and a lower frequency of Fms-like tyrosine kinase 3 internal tandem duplication (FLT3-ITD), NPM1 and CEBPA mutations. Complete remission rate and 3-year probability of event-free survival were significantly worse in 'AML-MRC' patients (67·7 vs. 85·6%, P < 0·01, 37·1% vs. 53·8%, P = 0·02, respectively), but 3-year overall survival and relapse-free survival were comparable with 'AML-NOS' patients. By multivariate analysis, FLT3-ITD was solely associated with worse overall survival. These results support the distinctive features of the category 'AML-MRC' even in children.
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Affiliation(s)
- Akitoshi Kinoshita
- Department of Paediatrics, St. Marianna University School of Medicine, Kawasaki, Japan
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Daraki A, Zachaki S, Koromila T, Diamantopoulou P, Pantelias GE, Sambani C, Aleporou V, Kollia P, Manola KN. The G⁵¹⁶T CYP2B6 germline polymorphism affects the risk of acute myeloid leukemia and is associated with specific chromosomal abnormalities. PLoS One 2014; 9:e88879. [PMID: 24586425 PMCID: PMC3933334 DOI: 10.1371/journal.pone.0088879] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 01/16/2014] [Indexed: 01/11/2023] Open
Abstract
The etiology of acute myeloid leukemia (AML) underlies the influence of genetic variants in candidate genes. The CYP2B6 enzyme detoxifies many genotoxic xenobiotics, protecting cells from oxidative damage. The CYP2B6 gene is subjected to a single-nucleotide polymorphism (G⁵¹⁶T) with heterozygotes (GT) and homozygotes (TT) presenting decreased enzymatic activity. This case-control study aimed to investigate the association of CYP2B6 G⁵¹⁶T polymorphism with the susceptibility of AML and its cytogenetic and clinical characteristics. Genotyping was performed on 619 AML patients and 430 healthy individuals using RCR-RFLP and a novel LightSNip assay. The major finding was a statistically higher frequency of the variant genotypes (GT and TT) in patients compared to the controls (GT:38.8% vs 29.8% and TT:9.3% vs 5.3% respectively) (p<0.001). More specifically, a significantly higher frequency of GT+TT genotypes in de novo AML patients (46.6%) and an immensely high frequency of TT in secondary AML (s-AML) (20.5%) were observed. The statistical analysis showed that the variant T allele was approximately 1.5-fold and 2.4-fold higher in de novo and s-AML respectively than controls. Concerning FAB subtypes, the T allele presented an almost 2-fold increased in AML-M2. Interestingly, a higher incidence of the TT genotype was observed in patients with abnormal karyotypes. In particular, positive correlations of the mutant allele were found in patients carrying specific chromosomal aberrations [-7/del(7q), -5/del(5q), +8, +21 or t(8;21)], complex or monosomal karyotypes. Finally, a strikingly higher frequency of TT genotype was also observed in patients stratified to the poor risk group. In conclusion, our results provide evidence for the involvement of the CYP2B6 polymorphism in AML susceptibility and suggest a possible role of the CYP2B6 genetic background on the development of specific chromosomal aberrations.
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Affiliation(s)
- Aggeliki Daraki
- Laboratory of Health Physics, Radiobiology & Cytogenetics, National Centre for Scientific Research (NCSR) “Demokritos”, Athens, Greece
- Department of Genetics & Biotechnology, Faculty of Biology, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophia Zachaki
- Laboratory of Health Physics, Radiobiology & Cytogenetics, National Centre for Scientific Research (NCSR) “Demokritos”, Athens, Greece
| | - Theodora Koromila
- Department of Genetics & Biotechnology, Faculty of Biology, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevi Diamantopoulou
- Laboratory of Health Physics, Radiobiology & Cytogenetics, National Centre for Scientific Research (NCSR) “Demokritos”, Athens, Greece
| | - Gabriel E. Pantelias
- Laboratory of Health Physics, Radiobiology & Cytogenetics, National Centre for Scientific Research (NCSR) “Demokritos”, Athens, Greece
| | - Constantina Sambani
- Laboratory of Health Physics, Radiobiology & Cytogenetics, National Centre for Scientific Research (NCSR) “Demokritos”, Athens, Greece
| | - Vasiliki Aleporou
- Department of Genetics & Biotechnology, Faculty of Biology, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagoula Kollia
- Department of Genetics & Biotechnology, Faculty of Biology, National and Kapodistrian University of Athens, Athens, Greece
| | - Kalliopi N. Manola
- Laboratory of Health Physics, Radiobiology & Cytogenetics, National Centre for Scientific Research (NCSR) “Demokritos”, Athens, Greece
- * E-mail:
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Mahmood H, Abdullah WZ, Yong AC, Ahmed SA, Abdullah AD, Baba AA, Ankathil R, Husin A, Hussein AR, Mustaffa R, Hassan R. A review of AML classification: a single institution experience in a developing country. J Hematop 2014. [DOI: 10.1007/s12308-014-0198-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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11
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Yanada M, Ohtake S, Miyawaki S, Sakamaki H, Sakura T, Maeda T, Miyamura K, Asou N, Oh I, Miyatake J, Kanbayashi H, Takeuchi J, Takahashi M, Dobashi N, Kiyoi H, Miyazaki Y, Emi N, Kobayashi Y, Ohno R, Naoe T. The demarcation between younger and older acute myeloid leukemia patients: a pooled analysis of 3 prospective studies. Cancer 2013; 119:3326-33. [PMID: 23798329 DOI: 10.1002/cncr.28212] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 04/22/2013] [Accepted: 05/01/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Contemporary treatment protocols for adult acute myeloid leukemia (AML) are age-specific, and older patients are generally treated less intensively than younger patients. However, it remains uncertain whether older but fit patients with AML really need to have their treatment attenuated. METHODS To evaluate the contribution of age to outcome for patients with AML receiving intensive chemotherapy, data were analyzed for 2276 patients aged less than 65 years who were treated uniformly, regardless of age, in 3 consecutive prospective studies conducted by the Japan Adult Leukemia Study Group. RESULTS A substantial drop in overall survival (OS) between patients aged 40 to 49 years and 50 to 64 years led to a focus on 2 comparisons: 1) age < 50 versus ≥ 50 years; and 2) age 50 to 54 versus 55 to 59 versus 60 to 64 years. OS was significantly better for patients aged < 50 years than that for those aged ≥ 50 years (49.6% and 37.0% at 5 years; P < .001); older patients were more susceptible to relapse, but not to early death or nonrelapse mortality. The significant differences in OS between these 2 age groups were equally seen for patients with favorable, intermediate, and adverse cytogenetics (P < .001 each). Outcomes for those aged 50 to 54, 55 to 59, and 60 to 64 years were similar, with 5-year OS rates of 38.2%, 35.1%, and 38.0%, respectively (P = .934), and no differences in early death or nonrelapse mortality were observed among these age groups. CONCLUSIONS These findings justify the use of intensive chemotherapy without dose attenuation toward older but fit patients with AML, at least up to the age of 64 years.
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Fernandez C, Santos-Silva MC, López A, Matarraz S, Jara-Acevedo M, Ciudad J, Gutierrez ML, Sánchez ML, Salvador-Osuna C, Berruezo MJ, Díaz-Arias JÁ, Palomo-Hernández AM, Colado E, González N, Gallardo D, Asensio A, García-Sánchez R, Saldaña R, Cerveró C, Carboné-Bañeres A, Gutierrez O, Orfao A. Newly diagnosed adult AML and MPAL patients frequently show clonal residual hematopoiesis. Leukemia 2013; 27:2149-56. [DOI: 10.1038/leu.2013.109] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 04/02/2013] [Accepted: 04/05/2013] [Indexed: 11/09/2022]
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13
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Maynadié M, De Angelis R, Marcos-Gragera R, Visser O, Allemani C, Tereanu C, Capocaccia R, Giacomin A, Lutz JM, Martos C, Sankila R, Johannesen TB, Simonetti A, Sant M. Survival of European patients diagnosed with myeloid malignancies: a HAEMACARE study. Haematologica 2013; 98:230-8. [PMID: 22983589 PMCID: PMC3561430 DOI: 10.3324/haematol.2012.064014] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 08/27/2012] [Indexed: 12/27/2022] Open
Abstract
Population-based information on the survival of patients with myeloid malignancies is rare mainly because some entities were not recognized as malignant until the publication of the third revision of the International Classification of Diseases for Oncology and World Health Organization classification in 2000. In this study we report the survival of patients with myeloid malignancies, classified by updated criteria, in Europe. We analyzed 58,800 cases incident between 1995 to 2002 in 48 population-based cancer registries from 20 European countries, classified into HAEMACARE myeloid malignancy groupings. The period approach was used to estimate 5-year relative survival in 2000-2002. The relative overall survival rate was 37%, but varied significantly between the major groups: being 17% for acute myeloid leukemia, 20% for myelodysplastic/myeloproliferative neoplasms, 31% for myelodysplastic syndromes and 63% for myeloproliferative neoplasms. Survival of patients with individual disease entities ranged from 90% for those with essential thrombocythemia to 4% for those with acute myeloid leukemia with multilineage dysplasia. Regional European variations in survival were conspicuous for myeloproliferative neoplasms, with survival rates being lowest in Eastern Europe. This is the first paper to present large-scale, European survival data for patients with myeloid malignancies using prognosis-based groupings of entities defined by the third revision of the International Classification of Diseases for Oncology/World Health Organization classifications. Poor survival in some parts of Europe, particularly for treatable diseases such as chronic myeloid leukemia, is of concern for hematologists and public health authorities.
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Affiliation(s)
- Marc Maynadié
- Registre des Hémopathies Malignes de Côte d'Or, EA 4184, Université de Bourgogne; Service d'Hématologie Biologique, CHU de Dijon, France
| | - Roberta De Angelis
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | - Rafael Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, and Catalan Institute of Oncology, Girona, Spain
| | - Otto Visser
- Comprehensive Cancer Centre, Utrecht, the Netherlands
| | - Claudia Allemani
- Analytical Epidemiology Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Cancer Research UK Cancer Survival Group, Non-Communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London UK
| | - Carmen Tereanu
- Analytical Epidemiology Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Riccardo Capocaccia
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | | | | | | | | | | | - Arianna Simonetti
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | - Milena Sant
- Analytical Epidemiology Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- HAEMACARE project leader
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Ohgami RS, Ma L, Ren L, Weinberg OK, Seetharam M, Gotlib JR, Arber DA. DNA methylation analysis of ALOX12 and GSTM1 in acute myeloid leukaemia identifies prognostically significant groups. Br J Haematol 2012; 159:182-90. [PMID: 22924777 DOI: 10.1111/bjh.12029] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 07/16/2012] [Indexed: 11/29/2022]
Abstract
To determine the role of DNA methylation in the progression of acute myeloid leukaemia (AML), we analysed the methylation status of ALOX12, GSTM1, HS3ST2 and FZD9 in 127 AML patients. Aberrant methylation of ALOX12 was associated with the subcategory AML with myelodysplasia-related changes (P = 0·0439) and specifically with megakaryocytic dysplasia (P = 0·0003). An association between HS3ST2 and AML patients with favourable cytogenetic risk was identified (P = 0·0469). In univariate and multivariate analysis, methylation of GSTM1 was associated with worse overall survival (OS) and disease-free survival (DFS), with hazard ratios of 2·57 and 1·86, respectively. Furthermore, the significance of methylation of GSTM1 in predicting poor prognosis was maintained within the subcategories of AML not otherwise specified (NOS), AML with intermediate cytogenetic risk and normal karyotype AML. Finally, patients with both GSTM1 and ALOX12 methylated, demonstrated worse outcomes when all AML patients were assessed (OS; P = 0·000411) as well as within AML NOS (DFS; P = 0·0023), AML with intermediate cytogenetic risk (OS; P = 0·0104) and normal karyotype AML (OS; P = 0·00636). This study implicates methylation of specific genes in the classification and prognostication of AML and suggests that the morphological feature of multilineage dysplasia may be a surrogate marker of gene methylation in at least a subset of AML cases.
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Affiliation(s)
- Robert S Ohgami
- Department of Pathology, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
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15
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Yang JJ, Cho SY, Suh JT, Lee HJ, Lee WI, Yoon HJ, Baek SK, Park TS. Detection of RUNX1-MECOM fusion gene and t(3;21) in a very elderly patient having acute myeloid leukemia with myelodysplasia-related changes. Ann Lab Med 2012; 32:362-5. [PMID: 22950073 PMCID: PMC3427825 DOI: 10.3343/alm.2012.32.5.362] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 05/17/2012] [Accepted: 07/19/2012] [Indexed: 11/19/2022] Open
Abstract
An 87-yr-old woman was diagnosed with AML with myelodysplasia-related changes (AML-MRC). The initial complete blood count showed Hb level of 5.9 g/dL, platelet counts of 27×109/L, and white blood cell counts of 85.33×109/L with 55% blasts. Peripheral blood samples were used in all the tests, as bone marrow examination could not be performed because of the patient's extremely advanced age and poor general health condition. Flow cytometric analysis, chromosome analysis, FISH, and reverse transcriptase-PCR (RT-PCR) results indicated AML-MRC resulting from t(3;21) with the RUNX1-MECOM fusion gene. To our knowledge, this is the second most elderly de novo AML patient associated with t(3;21) to be reported.
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Abstract
Farnesyltransferase inhibitors (FTIs) represent a new class of signal transduction inhibitors that block the processing of cellular polypeptides that have cysteine terminal residues and, by so doing, interdict multiple pathways involved in proliferation and survival of diverse malignant cell types. Tipifarnib is an orally bioavailable, nonpeptidomimetic methylquinolone FTI that has exhibited clinical activity in patients with myeloid malignancies including elderly adults with acute myelogenous leukemia (AML) who are not candidates for traditional cytotoxic chemotherapy, patients with high-risk myelodysplasia, myeloproliferative disorders, and imatinib-resistant chronic myelogenous leukemia. Because of its relatively low toxicity profile, tipifarnib provides an important alternative to traditional cytotoxic approaches for elderly patients who are not likely to tolerate or even benefit from aggressive chemotherapy. In this review, we will focus on the clinical development of tipifarnib for treatment of newly diagnosed AML, both as induction therapy for elderly adults with poor-risk AML and as maintenance therapy following achievement of first complete remission following induction and consolidation therapies for poor-risk AML. As with all other malignancies, the optimal approach is likely to lie in rational combinations of tipifarnib with cytotoxic, biologic and/or immunomodulatory agents with non-cross-resistant mechanisms of action. Gene expression profiling has identified networks of differentially expressed genes and gene combinations capable of predicting response to single agent tipifarnib. The clinical and correlative laboratory trials in progress and under development will provide the critical foundations for defining the optimal roles of tipifarnib and in patients with AMl and other hematologic malignancies.
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Affiliation(s)
- Judith E Karp
- Division of Hematologic Malignancies, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
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17
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Weinberg OK, Arber DA. Acute Myeloid Leukemia With Myelodysplasia-Related Changes: A New Definition. Surg Pathol Clin 2010; 3:1153-64. [PMID: 26839302 DOI: 10.1016/j.path.2010.09.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acute myeloid leukemia (AML) with multilineage dysplasia was introduced in the 2001 World Health Organization (WHO) classification to encompass cases of AML characterized by myelodysplastic syndrome-like features. The 2008 WHO classification revised this group into a new category, AML with myelodysplasia-related changes (AML-MRC). The category now includes patients with at least 20% blasts in peripheral blood or bone marrow and any of the following: (1) AML arising from a previous MDS or mixed MDS/myeloproliferative neoplasm, (2) AML with a specific MDS-associated cytogenetic abnormality and/or (3) AML with multilineage dysplasia. Up to 48% of all patients with AML are encompassed within the AML-MRC subgroup. AML-MRC patients have worse prognosis compared with patients with AML, not otherwise specified.
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Affiliation(s)
- Olga K Weinberg
- Department of Pathology, Stanford University Medical Center, 300 Pasteur Drive L235, Stanford, CA 94305, USA
| | - Daniel A Arber
- Department of Pathology, Stanford University Medical Center, 300 Pasteur Drive L235, Stanford, CA 94305, USA.
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18
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Park SH, Chi HS, Park SJ, Jang S, Park CJ. [Clinical importance of morphological multilineage dysplasia in acute myeloid leukemia with myelodysplasia related changes]. Korean J Lab Med 2010; 30:231-8. [PMID: 20603581 DOI: 10.3343/kjlm.2010.30.3.231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AML with myelodysplasia related changes (AML MRC) is known to show a poor prognosis compared with de novo AML, but controversies exist about the prognostic impact of multilineage dysplasia (MLD) among MRC. We investigated the prognostic impact of MLD in AML MRC. METHODS A total of 357 patients newly diagnosed as AML at Asan Medical Center from January 2001 to December 2005 were analyzed. They were diagnosed and classified as AML with recurrent genetic abnormalities, AML MRC, and AML not otherwise specified (AML NOS). Prognostic markers including overall survival (OS) and event free survival (EFS) were obtained through retrospective analysis of electronic medical records. RESULTS AML MRC patients showed a lower complete remission (CR) rate (44.7% vs. 64.9%, P=0.002) and shorter OS (297 vs. 561 days, P=0.004) and EFS (229 vs. 374 days, P=0.004) than AML NOS patients. Patients with MLD among AML MRC also showed a lower CR rate (37.7%, P=0.001) and shorter OS (351 days, P=0.036) and EFS (242 days, P=0.076) than AML NOS patients. However, among AML MRC patients, there were no differences in OS, EFS and CR between patients with and without MLD. CONCLUSIONS AML MRC patients showed a lower CR rate and shorter OS and EFS than AML NOS patients. AML MRC patients with MLD showed similar results and their prognosis was not different from those without MLD. MLD findings among AML MRC could be an independent poor prognostic factor in de novo AML.
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Affiliation(s)
- Sang Hyuk Park
- Department of Laboratory Medicine, University of Ulsan College of Medicine, Seoul, Korea
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19
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Multilineage dysplasia (MLD) in acute myeloid leukemia (AML) correlates with MDS-related cytogenetic abnormalities and a prior history of MDS or MDS/MPN but has no independent prognostic relevance: a comparison of 408 cases classified as "AML not otherwise specified" (AML-NOS) or "AML with myelodysplasia-related changes" (AML-MRC). Blood 2010; 116:2742-51. [PMID: 20581309 DOI: 10.1182/blood-2010-04-279794] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The World Health Organization classification of acute myeloid leukemia (AML) is hierarchically structured and integrates genetics, data on patients' history, and multilineage dysplasia (MLD). The category "AML with myelodysplastic syndrome (MDS)-related changes" (AML-MRC) is separated from "AML not otherwise specified" (AML-NOS) by presence of MLD, MDS-related cytogenetics, or history of MDS or MDS/myeloproliferative neoplasm (MPN). We analyzed 408 adult patients categorized as AML-MRC or AML-NOS. Three-year event-free survival (EFS; median, 13.8 vs 16.0 months) and 3-year overall survival (OS; 45.8% vs 53.9%) did not differ significantly between patients with MLD versus without. However, MLD correlated with preexisting MDS (P < .001) and MDS-related cytogenetics (P = .035). Patients with MLD as sole AML-MRC criterion (AML-MLD-sole; n = 90) had less frequently FLT3 internal tandem duplication (P = .032) and lower median age than AML-NOS (n = 232). Contrarily, patients with AML-NOS combined with AML-MLD-sole (n = 323) had better 3-year EFS (16.9 vs 10.7 months; P = .005) and 3-year OS (55.8% vs 32.5%; P = .001) than patients with history of MDS or MDS/MPN or MDS-related cytogenetics (n = 85). Gene expression analysis showed distinct clusters for AML-MLD-sole combined with AML-NOS versus AML with MDS-related cytogenetics or MDS history. Thus, MLD alone showed no independent clinical effect, whereas cytogenetics and MDS history were prognostically relevant.
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20
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Ma Y, Wang X, Xu X, Lin G. World Health Organization Sub-Types, Initial Treatment Outcome and Prognostic Study of Unselected Adult Patients with Acute Myeloid Leukaemia in Shanghai: An Analysis of 623 Cases. J Int Med Res 2009; 37:1191-201. [PMID: 19761704 DOI: 10.1177/147323000903700426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study investigated the complete remission (CR) rate and survival of 623 newly diagnosed patients with acute myeloid leukaemia (AML) in Shanghai, China, classified according to World Health Organization and French–American–British criteria, and compared the differences in treatment effect with those reported in developed countries and those reported in Shanghai from 1984 to 1994. Total CR rate was 66.5%, median survival was 18 months and estimated survival at 3 years was 30.8%. The 3-year relapse rate was 55.1%. These data showed that the CR rate was similar to that achieved in studies from developed countries, but long-term survival was worse. The CR rate and survival were increased markedly compared with data previously collected in Shanghai (1984-1994). Induction chemotherapeutic regimens based on idarubicin, daunorubicin or homoharringtonine all had similar CR rates and survivals. Karyotype was the most important prognostic factor. Multilineage dysplasia in de novo AML was not an independent prognostic factor. Improvement in the long-term treatment effect in China is an important challenge for the future.
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Affiliation(s)
- Y Ma
- Shanghai Leukaemia Cooperative Group, Department of Haematology, Huashan Hospital of Fudan University, Shanghai, China
| | - X Wang
- Shanghai Leukaemia Cooperative Group, Department of Haematology, Huashan Hospital of Fudan University, Shanghai, China
| | - X Xu
- Shanghai Leukaemia Cooperative Group, Department of Haematology, Huashan Hospital of Fudan University, Shanghai, China
| | - G Lin
- Shanghai Leukaemia Cooperative Group, Department of Haematology, Huashan Hospital of Fudan University, Shanghai, China
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21
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The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes. Blood 2009; 114:937-51. [PMID: 19357394 DOI: 10.1182/blood-2009-03-209262] [Citation(s) in RCA: 3094] [Impact Index Per Article: 206.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Recently the World Health Organization (WHO), in collaboration with the European Association for Haematopathology and the Society for Hematopathology, published a revised and updated edition of the WHO Classification of Tumors of the Hematopoietic and Lymphoid Tissues. The 4th edition of the WHO classification incorporates new information that has emerged from scientific and clinical studies in the interval since the publication of the 3rd edition in 2001, and includes new criteria for the recognition of some previously described neoplasms as well as clarification and refinement of the defining criteria for others. It also adds entities-some defined principally by genetic features-that have only recently been characterized. In this paper, the classification of myeloid neoplasms and acute leukemia is highlighted with the aim of familiarizing hematologists, clinical scientists, and hematopathologists not only with the major changes in the classification but also with the rationale for those changes.
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22
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Clinical characterization of acute myeloid leukemia with myelodysplasia-related changes as defined by the 2008 WHO classification system. Blood 2009; 113:1906-8. [DOI: 10.1182/blood-2008-10-182782] [Citation(s) in RCA: 126] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although some studies have validated the 2001 World Health Organization (WHO) classification of acute myeloid leukemia (AML), including the importance of multilineage dysplasia, others have suggested that multilineage dysplasia correlates with unfavorable cytogenetics but has no independent impact on prognosis. In 2008, the revised WHO classification has expanded this category into “AML with myelodysplasia-related changes” (AML-MRC). We evaluated the clinical, pathologic, cytogenetic, and molecular features of 100 AML patients using the 2008 WHO criteria. Patients underwent genetic screening for NPM1, FLT3-ITD, FLT3-D835, and CEBPA mutations. Compared with patients with AML, not otherwise specified, patients with AML-MRC were significantly older (P = .014), presented with a lower hemoglobin (P = .044), more frequently expressed CD14 (P = .048), and exhibited a decreased frequency of CEBPA mutations (P = .001). Multivariate analysis indicated that patients with AML-MRC had a significantly worse overall survival, progression-free survival, and complete response compared with AML-not otherwise specified (all P < .001). These data support the clinical, morphologic, and cytogenetic criteria for this 2008 WHO AML category.
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23
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Marisavljevic D, Markovic O, Zivkovic R. An unusual case of smoldering AML with prolonged indolent clinical course and spontaneous remission in the terminal phase. Med Oncol 2009; 26:476-9. [DOI: 10.1007/s12032-008-9153-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Accepted: 12/11/2008] [Indexed: 11/24/2022]
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24
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Karp JE, Smith BD, Gojo I, Lancet JE, Greer J, Klein M, Morris L, Levis MJ, Gore SD, Wright JJ, Garrett-Mayer E. Phase II trial of tipifarnib as maintenance therapy in first complete remission in adults with acute myelogenous leukemia and poor-risk features. Clin Cancer Res 2008; 14:3077-82. [PMID: 18483374 DOI: 10.1158/1078-0432.ccr-07-4743] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Acute myelogenous leukemia (AML) does not have a high cure rate, particularly in patients with poor-risk features. Such patients might benefit from additional therapy in complete remission (CR). Tipifarnib is an oral farnesyltransferase inhibitor with activity in AML. We conducted a phase II trial of maintenance tipifarnib monotherapy for 48 adults with poor-risk AML in first CR. EXPERIMENTAL DESIGN Tipifarnib 400 mg twice daily for 14 of 21 days was initiated after recovery from consolidation chemotherapy, for a maximum of 16 cycles (48 weeks). RESULTS Twenty (42%) patients completed 16 cycles, 24 (50%) were removed from study for relapse, and 4 (8%) discontinued drug prematurely for intolerance. Nonhematologic toxicities were rare, but tipifarnib dose was reduced in 58% for myelosuppression. Median disease-free survival (DFS) was 13.5 months (range, 3.5-59+ months), with 30% having DFS >2 years. Comparison of CR durations for 25 patients who received two-cycle timed sequential therapy followed by tipifarnib maintenance with 23 historically similar patients who did not receive tipifarnib showed that tipifarnib was associated with DFS prolongation for patients with secondary AML and adverse cytogenetics. CONCLUSIONS This study suggests that some patients with poor-risk AML, including patients with secondary AML and adverse cytogenetics, may benefit from tipifarnib maintenance therapy. Future studies are warranted to examine alternative tipifarnib dosing and continuation beyond 16 cycles.
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Affiliation(s)
- Judith E Karp
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD 21231-1000, USA.
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25
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Wakui M, Kuriyama K, Miyazaki Y, Hata T, Taniwaki M, Ohtake S, Sakamaki H, Miyawaki S, Naoe T, Ohno R, Tomonaga M. Diagnosis of acute myeloid leukemia according to the WHO classification in the Japan Adult Leukemia Study Group AML-97 protocol. Int J Hematol 2008; 87:144-151. [PMID: 18256787 PMCID: PMC2276241 DOI: 10.1007/s12185-008-0025-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Revised: 10/30/2007] [Accepted: 11/02/2007] [Indexed: 11/25/2022]
Abstract
We reviewed and categorized 638 of 809 patients who were registered in the Japan Adult Leukemia Study Group acute myeloid leukemia (AML)-97 protocol using morphological means. Patients with the M3 subtype were excluded from the study group. According to the WHO classification, 171 patients (26.8%) had AML with recurrent genetic abnormalities, 133 (20.8%) had AML with multilineage dysplasia (MLD), 331 (51.9%) had AML not otherwise categorized, and 3 (0.5%) had acute leukemia of ambiguous lineage. The platelet count was higher and the rate of myeloperoxidase (MPO)-positive blasts was lower in AML with MLD than in the other WHO categories. The outcome was significantly better in patients with high (≥50%) than with low (<50%) ratios of MPO-positive blasts (P < 0.01). The 5-year survival rates for patients with favorable, intermediate, and adverse karyotypes were 63.4, 39.1, and 0.0%, respectively, and 35.5% for those with 11q23 abnormalities (P < 0.0001). Overall survival (OS) did not significantly differ between nine patients with t(9;11) and 23 with other 11q23 abnormalities (P = 0.22). Our results confirmed that the cytogenetic profile, MLD phenotype, and MPO-positivity of blasts are associated with survival in patients with AML, and showed that each category had the characteristics of the WHO classification such as incidence, clinical features, and OS.
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Affiliation(s)
- Moe Wakui
- Department of Clinical Laboratory Sciences, Hematoimmunology, School of Health Science, Faculty of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan
| | - Kazutaka Kuriyama
- Department of Clinical Laboratory Sciences, Hematoimmunology, School of Health Science, Faculty of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan.
| | - Yasushi Miyazaki
- Department of Hematology, Atomic Bomb Disease Institute, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Tomoko Hata
- Department of Hematology, Atomic Bomb Disease Institute, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Masafumi Taniwaki
- Department of Hematology and Oncology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shigeki Ohtake
- Department of Clinical Laboratory Science, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Hisashi Sakamaki
- Department of Hematology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Shuichi Miyawaki
- Department of Hematology, Saiseikai Maebashi Hospital, Maebashi, Japan
| | - Tomoki Naoe
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryuzo Ohno
- Aichi Cancer Center, Nagoya, Aichi, Japan
| | - Masao Tomonaga
- Department of Hematology, Atomic Bomb Disease Institute, Nagasaki University School of Medicine, Nagasaki, Japan
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26
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Current Awareness in Hematological Oncology. Hematol Oncol 2005. [DOI: 10.1002/hon.730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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