ACUTE MYELOID LEUKEMIA WITH MYELODISPLASIA-RELATED CHANGES: A REVIEW OF 58 CASES AT A SINGLE CENTRE
(Abstract release date: 05/19/16)
EHA Library. Martin-Batista S. 06/09/16; 134571; PB1671
Dr. Silvia Martin-Batista
Contributions
Contributions
Abstract
Abstract: PB1671
Type: Publication Only
Background
The WHO-defined category (2008) of acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) includes cases with 20% or more blasts in the peripheral blood or BM and (1) dysplastic morphology in 50% or more of the cells in two or more myeloid lineages and/or (2) a preceding MDS or MDS/MPN phase and/or (3) specific myelodysplasia-related genetic abnormalities. In consecuense, this is a heterogeneous disorder defined by morphologic, genetic, or clinical features.
Aims
Our objective was to analyze the main characteristics of patients with a diagnosis of AML-MRC who were treated and followed in our institution.
Methods
We have retrospectively studied all the cases of AML-MRC that were seen at our hospital in the last fiveteen years. Main recorded data included age, sex, a previous diagnosis of myelodysplastic síndrome (MDS), peripheral blood cell counts, serum lactate-dehydrogenase level, bone marrow aspirate features, cytogenetics, immunophenotype by flow cytometry, therapeutic approach, response to treatment, overall survival and mortality. Statistical analysis was performed using the SPSS 17.0 version.
Results
From 2001 to 2015, 58 patients were diagnosed with AML-MRC at our hospital. Mean age at diagnosis was 72 years (median 75, range 23-90) and 60,3% were men. A previous diagnosis of MDS was noted in 43 patients (74%), with the following distribution: refractory cytopenia with multilineage dysplasia, 22 cases (38%); RAEB-1 or 2, 17 (29%); refractory anemia, 3 (5%); and refractory anemia with ring sideroblasts, 1 (1,7%). According to WHO criteria, cytogenetic abnormalities sufficient to diagnose AML-MRC were found in 7/31 patients with a conclusive caryotypic result (22,6%). A diagnosis of AML-MRC based only in morphological findings was performed in 9 patients (15,5%).With respect to the findings on blood at diagnosis, leukopenia was present in 53% and leukocytosis in 28%; anemia in 93% (macrocytic 30%) and thrombopenia in 84%. Pancytopenia was found in 47% of cases and a high level of serum lactate-dehydrogenase in 42%. The more frequent phenotypic markers of blast cells, analysed by flow cytometry, were HLA-DR (80% of cases), CD34 (74%), CD33 (72%), CD13 (68%), CD117 (68%), CD38 (62%) and MPO (48%). Some aberrant expressions were found, being CD7 positivity the most frequent (34% of cases); positivities for CD56 (10%) and CD4 (3%) were also observed.The “3+7” induction regimen was applied in 24% of patients, while 5-azacytidine was the drug of choice in 21%. Paliative or supportive treatment was used in the majority of cases (55%). Nine of 14 patients (64%) obtained complete remission after “3+7” scheme (four still alive), and only one (8%) among those treated with 5-azacytidine. At the moment of closing this study, 52 patients had died (89,7%), with a mean overall survival of 14 months (range 0-60), and 6 were still alive after a mean follow-up of 53 months (range 16-168). Mean age of survivors at diagnosis was 57.5 years, compared with 74 years of that who have died. Among the recorded data, those associated with a better outcome were younger age (p=0.028), positivity for CD56 (p=0.005) and intensive treatment (p=0.026).
Conclusion
In our experience, AML-MRC occurs mainly in elderly patients and is associated with a poor prognosis. The age at diagnosis (and therefore, the probability of receiving intensive chemotherapy) seems to be a strong determinant of prognosis; also, CD56-positive cases exhibited a lower mortality rate than those negative. Further studies are needed to confirm these findings and new therapeutic strategies should be investigated to improve outcome in this group of patients.
Session topic: E-poster
Keyword(s): AML, Elderly, Myelodysplasia
Type: Publication Only
Background
The WHO-defined category (2008) of acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) includes cases with 20% or more blasts in the peripheral blood or BM and (1) dysplastic morphology in 50% or more of the cells in two or more myeloid lineages and/or (2) a preceding MDS or MDS/MPN phase and/or (3) specific myelodysplasia-related genetic abnormalities. In consecuense, this is a heterogeneous disorder defined by morphologic, genetic, or clinical features.
Aims
Our objective was to analyze the main characteristics of patients with a diagnosis of AML-MRC who were treated and followed in our institution.
Methods
We have retrospectively studied all the cases of AML-MRC that were seen at our hospital in the last fiveteen years. Main recorded data included age, sex, a previous diagnosis of myelodysplastic síndrome (MDS), peripheral blood cell counts, serum lactate-dehydrogenase level, bone marrow aspirate features, cytogenetics, immunophenotype by flow cytometry, therapeutic approach, response to treatment, overall survival and mortality. Statistical analysis was performed using the SPSS 17.0 version.
Results
From 2001 to 2015, 58 patients were diagnosed with AML-MRC at our hospital. Mean age at diagnosis was 72 years (median 75, range 23-90) and 60,3% were men. A previous diagnosis of MDS was noted in 43 patients (74%), with the following distribution: refractory cytopenia with multilineage dysplasia, 22 cases (38%); RAEB-1 or 2, 17 (29%); refractory anemia, 3 (5%); and refractory anemia with ring sideroblasts, 1 (1,7%). According to WHO criteria, cytogenetic abnormalities sufficient to diagnose AML-MRC were found in 7/31 patients with a conclusive caryotypic result (22,6%). A diagnosis of AML-MRC based only in morphological findings was performed in 9 patients (15,5%).With respect to the findings on blood at diagnosis, leukopenia was present in 53% and leukocytosis in 28%; anemia in 93% (macrocytic 30%) and thrombopenia in 84%. Pancytopenia was found in 47% of cases and a high level of serum lactate-dehydrogenase in 42%. The more frequent phenotypic markers of blast cells, analysed by flow cytometry, were HLA-DR (80% of cases), CD34 (74%), CD33 (72%), CD13 (68%), CD117 (68%), CD38 (62%) and MPO (48%). Some aberrant expressions were found, being CD7 positivity the most frequent (34% of cases); positivities for CD56 (10%) and CD4 (3%) were also observed.The “3+7” induction regimen was applied in 24% of patients, while 5-azacytidine was the drug of choice in 21%. Paliative or supportive treatment was used in the majority of cases (55%). Nine of 14 patients (64%) obtained complete remission after “3+7” scheme (four still alive), and only one (8%) among those treated with 5-azacytidine. At the moment of closing this study, 52 patients had died (89,7%), with a mean overall survival of 14 months (range 0-60), and 6 were still alive after a mean follow-up of 53 months (range 16-168). Mean age of survivors at diagnosis was 57.5 years, compared with 74 years of that who have died. Among the recorded data, those associated with a better outcome were younger age (p=0.028), positivity for CD56 (p=0.005) and intensive treatment (p=0.026).
Conclusion
In our experience, AML-MRC occurs mainly in elderly patients and is associated with a poor prognosis. The age at diagnosis (and therefore, the probability of receiving intensive chemotherapy) seems to be a strong determinant of prognosis; also, CD56-positive cases exhibited a lower mortality rate than those negative. Further studies are needed to confirm these findings and new therapeutic strategies should be investigated to improve outcome in this group of patients.
Session topic: E-poster
Keyword(s): AML, Elderly, Myelodysplasia
Abstract: PB1671
Type: Publication Only
Background
The WHO-defined category (2008) of acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) includes cases with 20% or more blasts in the peripheral blood or BM and (1) dysplastic morphology in 50% or more of the cells in two or more myeloid lineages and/or (2) a preceding MDS or MDS/MPN phase and/or (3) specific myelodysplasia-related genetic abnormalities. In consecuense, this is a heterogeneous disorder defined by morphologic, genetic, or clinical features.
Aims
Our objective was to analyze the main characteristics of patients with a diagnosis of AML-MRC who were treated and followed in our institution.
Methods
We have retrospectively studied all the cases of AML-MRC that were seen at our hospital in the last fiveteen years. Main recorded data included age, sex, a previous diagnosis of myelodysplastic síndrome (MDS), peripheral blood cell counts, serum lactate-dehydrogenase level, bone marrow aspirate features, cytogenetics, immunophenotype by flow cytometry, therapeutic approach, response to treatment, overall survival and mortality. Statistical analysis was performed using the SPSS 17.0 version.
Results
From 2001 to 2015, 58 patients were diagnosed with AML-MRC at our hospital. Mean age at diagnosis was 72 years (median 75, range 23-90) and 60,3% were men. A previous diagnosis of MDS was noted in 43 patients (74%), with the following distribution: refractory cytopenia with multilineage dysplasia, 22 cases (38%); RAEB-1 or 2, 17 (29%); refractory anemia, 3 (5%); and refractory anemia with ring sideroblasts, 1 (1,7%). According to WHO criteria, cytogenetic abnormalities sufficient to diagnose AML-MRC were found in 7/31 patients with a conclusive caryotypic result (22,6%). A diagnosis of AML-MRC based only in morphological findings was performed in 9 patients (15,5%).With respect to the findings on blood at diagnosis, leukopenia was present in 53% and leukocytosis in 28%; anemia in 93% (macrocytic 30%) and thrombopenia in 84%. Pancytopenia was found in 47% of cases and a high level of serum lactate-dehydrogenase in 42%. The more frequent phenotypic markers of blast cells, analysed by flow cytometry, were HLA-DR (80% of cases), CD34 (74%), CD33 (72%), CD13 (68%), CD117 (68%), CD38 (62%) and MPO (48%). Some aberrant expressions were found, being CD7 positivity the most frequent (34% of cases); positivities for CD56 (10%) and CD4 (3%) were also observed.The “3+7” induction regimen was applied in 24% of patients, while 5-azacytidine was the drug of choice in 21%. Paliative or supportive treatment was used in the majority of cases (55%). Nine of 14 patients (64%) obtained complete remission after “3+7” scheme (four still alive), and only one (8%) among those treated with 5-azacytidine. At the moment of closing this study, 52 patients had died (89,7%), with a mean overall survival of 14 months (range 0-60), and 6 were still alive after a mean follow-up of 53 months (range 16-168). Mean age of survivors at diagnosis was 57.5 years, compared with 74 years of that who have died. Among the recorded data, those associated with a better outcome were younger age (p=0.028), positivity for CD56 (p=0.005) and intensive treatment (p=0.026).
Conclusion
In our experience, AML-MRC occurs mainly in elderly patients and is associated with a poor prognosis. The age at diagnosis (and therefore, the probability of receiving intensive chemotherapy) seems to be a strong determinant of prognosis; also, CD56-positive cases exhibited a lower mortality rate than those negative. Further studies are needed to confirm these findings and new therapeutic strategies should be investigated to improve outcome in this group of patients.
Session topic: E-poster
Keyword(s): AML, Elderly, Myelodysplasia
Type: Publication Only
Background
The WHO-defined category (2008) of acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) includes cases with 20% or more blasts in the peripheral blood or BM and (1) dysplastic morphology in 50% or more of the cells in two or more myeloid lineages and/or (2) a preceding MDS or MDS/MPN phase and/or (3) specific myelodysplasia-related genetic abnormalities. In consecuense, this is a heterogeneous disorder defined by morphologic, genetic, or clinical features.
Aims
Our objective was to analyze the main characteristics of patients with a diagnosis of AML-MRC who were treated and followed in our institution.
Methods
We have retrospectively studied all the cases of AML-MRC that were seen at our hospital in the last fiveteen years. Main recorded data included age, sex, a previous diagnosis of myelodysplastic síndrome (MDS), peripheral blood cell counts, serum lactate-dehydrogenase level, bone marrow aspirate features, cytogenetics, immunophenotype by flow cytometry, therapeutic approach, response to treatment, overall survival and mortality. Statistical analysis was performed using the SPSS 17.0 version.
Results
From 2001 to 2015, 58 patients were diagnosed with AML-MRC at our hospital. Mean age at diagnosis was 72 years (median 75, range 23-90) and 60,3% were men. A previous diagnosis of MDS was noted in 43 patients (74%), with the following distribution: refractory cytopenia with multilineage dysplasia, 22 cases (38%); RAEB-1 or 2, 17 (29%); refractory anemia, 3 (5%); and refractory anemia with ring sideroblasts, 1 (1,7%). According to WHO criteria, cytogenetic abnormalities sufficient to diagnose AML-MRC were found in 7/31 patients with a conclusive caryotypic result (22,6%). A diagnosis of AML-MRC based only in morphological findings was performed in 9 patients (15,5%).With respect to the findings on blood at diagnosis, leukopenia was present in 53% and leukocytosis in 28%; anemia in 93% (macrocytic 30%) and thrombopenia in 84%. Pancytopenia was found in 47% of cases and a high level of serum lactate-dehydrogenase in 42%. The more frequent phenotypic markers of blast cells, analysed by flow cytometry, were HLA-DR (80% of cases), CD34 (74%), CD33 (72%), CD13 (68%), CD117 (68%), CD38 (62%) and MPO (48%). Some aberrant expressions were found, being CD7 positivity the most frequent (34% of cases); positivities for CD56 (10%) and CD4 (3%) were also observed.The “3+7” induction regimen was applied in 24% of patients, while 5-azacytidine was the drug of choice in 21%. Paliative or supportive treatment was used in the majority of cases (55%). Nine of 14 patients (64%) obtained complete remission after “3+7” scheme (four still alive), and only one (8%) among those treated with 5-azacytidine. At the moment of closing this study, 52 patients had died (89,7%), with a mean overall survival of 14 months (range 0-60), and 6 were still alive after a mean follow-up of 53 months (range 16-168). Mean age of survivors at diagnosis was 57.5 years, compared with 74 years of that who have died. Among the recorded data, those associated with a better outcome were younger age (p=0.028), positivity for CD56 (p=0.005) and intensive treatment (p=0.026).
Conclusion
In our experience, AML-MRC occurs mainly in elderly patients and is associated with a poor prognosis. The age at diagnosis (and therefore, the probability of receiving intensive chemotherapy) seems to be a strong determinant of prognosis; also, CD56-positive cases exhibited a lower mortality rate than those negative. Further studies are needed to confirm these findings and new therapeutic strategies should be investigated to improve outcome in this group of patients.
Session topic: E-poster
Keyword(s): AML, Elderly, Myelodysplasia
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