Association of Leukemia Cutis With Survival in Acute Myeloid Leukemia

Abstract

IMPORTANCE Leukemia cutis (LC) is an important yet understudied extramedullary manifestation of leukemia. Previous reports have suggested poor prognosis for patients with LC, but these reports have largely consisted of descriptive studies with a limited number of patients. OBJECTIVES To identify patient factors associated with LC and characterize the association of LC with the course of acute myeloid leukemia (AML). DESIGN, SETTING, AND PARTICIPANTS This retrospective, matched-cohort study included 1683 patients with AML diagnosed from January 1, 2005, to April 1, 2017, with and without biopsy-proven LC seen at a single-center, tertiary care hospital in St Louis, Missouri. To specifically evaluate differences in survival, propensity scoring was used to match patients with AML with LC to patients with AML without LC off the logit of propensity score based on age, race/ethnicity, sex, and leukemia type. Kaplan-Meier methods were used to compare cumulative probability survival. Matched survival analysis was performed with extended Cox regression to determine factors associated with leukemia-specific and overall survival. MAIN OUTCOMES AND MEASURES Leukemia-specific survival and overall survival. RESULTS A total of 1683 patients were reviewed, including 78 patients with biopsy-proven LC of the AML type and 1605 patients with AML without LC. A total of 62 of the patients with AML and LC (mean [SD] age, 58.2 [11.7] years; 33 [53.2%] male) were matched in a 1:3 ratio to 186 patients with AML without LC (mean [SD] age, 58.2 [13.5] years; 103 [55.4%] male). The 5-year survival among the 62 patients with AML with LC was 8.6%, shorter than the 28.3% among the 186 matched patients with AML without LC. Matched survival analysis revealed that patients with AML and LC compared with those without LC had hazard ratios of 2.06 (95% CI, 1.26-3.38; P = .004) for leukemia-specific death and of 1.66 (95% CI, 1.06-2.60; P = .03) for all-cause death. In addition, matched patients with LC had greater odds of extramedullary organ burden (odds ratio, 3.48; 95% CI, 1.72-7.05; P < .001). CONCLUSIONS AND RELEVANCE The results suggest that the presentation of LC in patients with AML is associated with decreased overall survival and leukemia-specific survival. Patients with AML presenting with LC may require more intensive treatment and monitoring of their leukemic disease.

NPM1 and FLT3-TKD mutations are enriched in patients with leukemia cutis

“…Ganzel and colleagues, however, demonstrate that after adjusting for known prognostic risk factors such as older age, high white blood cell count, and cytogenetic risk factors, the presence of extramedullary disease did not have prognostic significance [28]. In contrast, Wang and co-authors found that patients with AML and LC as compared to those without LC had a hazard ratio of 2.06 for leukemia-specific death, after controlling for similar risk factors as Ganzel [29]. We did not find a statistical difference between the known prognostic risk factor-based predictions and the overall survival in our cohort.…”

“…Historically, LC has been believed to be associated with poor prognosis. However, modern assessment of patients with leukemia cutis in the context of genetic abnormalities and modern treatments has yielded mixed results [28,29].…”

Infant Acute Myeloid Leukemia: A Unique Clinical and Biological Entity

“…Leukemia cutis (LC), also known as cutaneous myeloid sarcoma is not limited to neonatal period and remains common in infant leukemia. LC is commonly seen in FAB-4 and 5 AML [ 17 , 18 , 19 ]. Patients present with diffuse and papulonodular erythematous or violaceous skin lesions corresponding to leukemia infiltration into the epidermis, dermis or subcutaneous tissues [ 20 ].…”

“…In the French ELAM02 cohort, skin involvement was significatively more prevalent in infants occurring in 14.5% of children less than 2 years old compared to 2.6% of older children [ 1 , 19 ]. This presentation is associated with other extra-medullary organ involvement in AML and is negatively associated with prognosis [ 17 , 18 , 19 ]. One hypothesis is that chemotherapy sufficient to induce remission in bone marrow may not be sufficient to penetrate the skin, thus leading to a greater incidence of relapse in those patients.…”

Specific cutaneous infiltrates in patients with haematological neoplasms: a retrospective study with 49 patients

“…Cutaneous involvement usually occurs in the setting of bone marrow, internal organ and peripheral blood involvement, portending a poor outcome. Therefore, it is of paramount importance to screen all patients with specific cutaneous lesions of leukaemia to exclude simultaneous internal organ disease 17,18 …”