Genetic Profiles and Risk Stratification in Adult De Novo Acute Myeloid Leukaemia in Relation to Age, Gender, and Ethnicity: A Study from Malaysia

Abstract

Hitherto, no data describing the heterogeneity of genetic profiles and risk stratifications of adult acute myeloid leukaemia (AML) in Southeast Asia are reported. This study assessed genetic profiles, Moorman’s hierarchical classification, and ELN 2017-based risk stratifications in relation to age, gender, and ethnicity in Malaysian adult AML patients. A total of 854 AML patients: male (52%), female (48%) were recruited comprising three main ethnic groups: Malays (59%), Chinese (32%) and Indians (8%). Of 307 patients with abnormal karyotypes: 36% exhibited translocations; 10% deletions and 5% trisomies. The commonest genotype was FLT3-ITD-NPM1wt (276/414; 66.7%). ELN 2017 risk stratification was performed on 494 patients, and 41% were classified as favourable, 39% as intermediate and 20% as adverse groups. More females (47%) were in the favourable risk group compared to males (37%), whereas adverse risk was higher in patients above 60 (24%) of age compared to below 60 (18%) patients. We observed heterogeneity in the distribution of genetic profiles and risk stratifications between the age groups and gender, but not among the ethnic groups. Our study elucidated the diversity of adult AML genetic profiles between Southeast Asians and other regions worldwide.

Cytogenetic profile of 1791 adult acute myeloid leukemia in India

“…Our t(15;17), t(8;21) and inv(16), though seen in all age groups, were most common in patients below 40 years, similar to most reports from S.E.Asia [ 11 , 21 , 24 , 25 ]. However, the t(15;17) and t(8;21) were equally common at 40–49 years (28% and 25% respectively) in one Chinese study each [ 11 , 21 ].…”

“…The age distribution of abnormalities was also approximately the same across each decade unlike the West in which deletions and trisomies increased with age (51% and 35% respectively in those ≥ 60 years) [ 12 , 13 , 15 , 35 ]. The peak age of our normal karyotypes (40–49 years) was two decades lower than in the West (≥ 60 years); it differed from both Malaysian reports (50–59 years and ≤ 30 years) [ 12 , 15 , 16 , 21 , 24 , 25 , 35 ].…”

“…The decline in the number of patients after the sixth decade (13% ≥ 60 years) was similar to several reports from Asia (14–24% ≥ 60 years) but unlike Korea and the West (34–77% ≥ 60 years) [ 11 , 15 , 16 , 18 , 21 – 25 , 35 ]. The age distribution of abnormalities was also approximately the same across each decade unlike the West in which deletions and trisomies increased with age (51% and 35% respectively in those ≥ 60 years) [ 12 , 13 , 15 , 35 ].…”

“…These reports varied with respect to the criteria used for inclusion as shown in Tables 5 , 6 , 7 . Some studies categorised patients hierarchically [ 9 , 11 , 13 , 16 , 22 , 25 ]. Others did not include one or more of the following major abnormalities: the t(15;17), the inv(16) and trisomy 8 [ 9 , 11 , 12 , 15 , 19 ].…”

Nomogram to Predict Clinical Outcome in FLT3-ITD Acute Myeloid Leukemia

“…CR1 and with the favorable prognosis gene were the good factors for RFS. Age has been well recognized as an important clinical variable, which is elaborated in all kinds of AML not just the one of FLT3-ITD AML [15]. Older patients usually have more complications and lower response to induction therapy.…”