Reasons for treating secondary AML as de novo AML

Abstract

In a Danish bi-regional registry-based study, we conducted an analysis of the incidence and clinical importance of secondary acute myeloid leukaemia (AML). In a total of 630 cases of AML, we found 157 (25%) cases of secondary AML. The secondary leukaemia arose from MDS (myelodysplastic syndrome) in 77 cases (49%), CMPD (chronic myeloproliferative disorder) in 43 cases (27%) and was therapy-related AML (t-AML) in 37 cases (24%). Median age at diagnosis of AML was 69 yr in secondary cases when compared to 66 yr in de novo cases (P = 0.006). In univariate analyses, secondary AML was associated with an inferior complete remission (CR) rate (P = 0.008) and poorer overall survival (OS, P = 0.003) whereas in complete remitters, disease-free survival (DFS) of secondary cases was equal to that of de novo cases. Interestingly, in all further analyses of CR-rates, OS and DFS, when correcting for the influence of age, cytogenetic abnormalities, performance status and leucocyte count (WBC), presence of secondary AML completely lost prognostic significance. We conclude that the presence of secondary AML does not per se convey an unfavourable prognosis and that patients with secondary AML should be offered the chance of benefiting from treatment according to current frontline AML protocols.

Characterization and prognostic features of secondary acute myeloid leukemia in a population‐based setting: A report from the Swedish Acute Leukemia Registry

“…The proportion of patients with secondary AML found in our study (26.4%) was also higher compared to most previous studies [3,[20][21][22]. The proportion of patients with t-AML (7.7%) is slightly higher compared to most other studies [2,3,7,[19][20][21], which could be due to our rigorous reporting of the primary disease, also including nonmalignant diseases treated by chemotherapy and/or radiation. T-AML was defined as any exposure to a cytotoxic agent or radiation, regardless of dose or the time of exposure.…”

“…The high median age of 71 years in this study demonstrate its true population-based nature with a median age substantially higher when compared with previous reports on secondary AML [2,6,8,18,19]. The proportion of patients with secondary AML found in our study (26.4%) was also higher compared to most previous studies [3,[20][21][22].…”

“…Secondary acute myeloid leukemia (AML) refers to the development of AML after myelodysplastic syndromes (MDS) or myeloproliferative neoplasms (MPN) [1,2]. The term also includes AML patients with prior exposure to cytotoxic therapy and/or radiotherapy for a malignant or nonmalignant disease (therapy-related AML or t-AML) [1].…”

“…This is due to the fact that secondary AML is associated to factors that confer a poor prognosis such as high age and high-risk cytogenetics [2,7,8]. Only few and smaller studies have previously analyzed the features and the prognostic impact of secondary AML in a population-based setting.…”

“…Only few and smaller studies have previously analyzed the features and the prognostic impact of secondary AML in a population-based setting. Recently, a Danish bi-regional study presented data on 157 secondary AML patients and found no prognostic impact of secondary AML when correcting for factors such as age, cytogenetic risk, performance status, and WBC [2].…”