Prognostic factors and treatment outcome in 1,516 adult patients with de novo and secondary acute myeloid leukemia in 1999–2009 in 5 hematology intensive care centers in the Czech Republic

Abstract

Acute myeloid leukemia (AML) is a severe condition with a high mortality. When making decisions about the optimal tailor-made therapy, numerous prognostic factors are considered. The study represents a detailed analysis of the role of these factors and treatment outcomes based on a long-term follow-up of patients treated in 5 hematology intensive care centers in the Czech Republic.The studied group comprised 1,188 patients with de novo AML and 328 patients with secondary AML. The latter were significantly older, had more unfavorable cytogenetic changes and less frequently received curative therapy. Curatively treated patients achieved fewer complete remissions and relapsed more often than those with de novo AML. Patients with secondary AML had lower rates of allogeneic transplantation as part of consolidation therapy and a significantly shorter median overall survival. A lower proportion of the patients were alive at the time of analysis.However, the treatment outcome of de novo AML patients is not satisfactory, the only exception being those with acute promyelocytic leukemia. The analysis, which did not evaluate the intention-to-treat criteria and was without randomization, found allogeneic stem cell transplantation to be the most effective modality of consolidation therapy in both groups of patients.

Genetic Abnormalities and Challenges in the Treatment of Acute Myeloid Leukemia

“…8 This is largely due to the high percentage of secondary AML associated with multidrug resistance (MDR) mechanisms: up to 70% of secondary AML patients show overexpression of P-glycoprotein (Pgp) or other MDR mechanisms. 9 The genetic changes in leukemic blasts make them ineffective at generating mature red blood cells, neutrophils, monocytes, and platelets. In addition, these AML blasts also inhibit normal blasts from differentiating into mature progeny.…”

Easily manageable prognostic factors in 152 Chinese elderly acute myeloid leukemia patients: a single-center retrospective study

“…In a long-term follow-up from five hematological intensive care centers, age was one of the most important prognostic factors for overall AML patients [23] , [24] . Our data from 152 elderly patients also confirmed that older age predicts shorter OS and RFS and lower CR rate in elderly AML patients.…”

Molecular Markers for Risk Stratification in Adult Acute Myeloid Leukemia with Normal Cytogenetics

“…These detected chromosomal aberrations are the most important tool to classify patients at their initial diagnosis and to divide them into favorable, intermediate and unfavorable subgroups. The age of the patient is also an important prognostic factor (Juliusson et al, 2009;Szotkowski et al, 2010). However, approximately 45% of adult patients with AML have normal karyotype (cytogenetically normal /CN/-AML patients) and are usually classified as an intermediate risk group (Mrozek et al, 2007;Smith et al, 2011).…”