Retinal Abnormalities in Newly Diagnosed Adult Acute Myeloid Leukemia

Abstract

Retinal abnormalities (RA) are very frequently observed in adult patients with acute myeloid leukemia (AML), but the clinical significance of these findings has not been fully investigated. We examined the fundus oculi in a cohort of 122 adult patients with AML at presentation and analyzed some clinical and biological features to assess whether there was any association with RA. For this purpose, we subdivided the patients into two groups according to the presence or absence of RA (groups 1 and 2, respectively). We considered current laboratory parameters such as white blood cell (WBC) count, hemoglobin (Hb), platelets and serum lactate dehydrogenase (LDH). Moreover, we subdivided the patients into two groups according to age <60 (group A) or ≧60 years (group B) to evaluate a possible association between RA and response to treatment and/or overall survival (OS). In our series, a higher median age and a lower Hb value were associated with group 1 (p = 0.001 and p = 0.04, respectively); the median LDH value was 812 U/l (range 224–5,551) and 607 (range 181–5,244) for groups 1 and 2, respectively (p = 0.02). There was no association between RA and karyotypic alterations. In terms of outcome, in group A (<60 years), 80% patients who achieved complete remission (CR) were in group 2 vs. 13% nonresponders (NR) (p < 0.0001). Median OS of group 2 patients was 49.7 months compared with 7.2 months for those in group 1 (p = 0.002). In group B, 58% patients who achieved CR were in group 1 vs. 15% NR (p < 0.006). Median OS of patients in group 2 was 14.6 months compared with 2.9 months in group 1 (p = 0.02). Our data show that RA are significantly associated with some biological features and with shorter OS in AML patients and this parameter seems to be an effective clinical sign of poor prognosis in terms of CR.

Chronic myelocytic leukemic fundus lesion: A case report

“…Retinopathy is an important clinical manifestation that determines poor prognosis in patients in the remission period. The complete remission rate and survival rate of young patients who do not have retinopathy are significantly higher than those of older patients with retinopathy (15). CML in the patient in the current study was detected at an early stage, and no cotton wool spots were observed in the fundus.…”

“…In addition, the binocular retina had a large number of bleeding spots, and all bleeding spots had a white center. Specchia et al (15) reported that patients with leukemia who had retinopathy exhibited an increased level of blood lactate dehydrogenase, with an average of 812 IU/l, whilst patients who did not have retinopathy displayed a mean blood lactate dehydrogenase level of 607 IU/l. The blood lactate dehydrogenase level of the current patient was increased to 860 IU/l (normal range, 100-300 IU/l), which was consistent with the literature (15).…”

“…Specchia et al (15) reported that patients with leukemia who had retinopathy exhibited an increased level of blood lactate dehydrogenase, with an average of 812 IU/l, whilst patients who did not have retinopathy displayed a mean blood lactate dehydrogenase level of 607 IU/l. The blood lactate dehydrogenase level of the current patient was increased to 860 IU/l (normal range, 100-300 IU/l), which was consistent with the literature (15). With regards to the prognosis of CML, certain studies have reported that acute leukemic patients over 40 years-of-age with cotton wool spots in the fundus had a worse prognosis, and the impact of cotton wool spots was greater than that of age in terms of prognosis (9).…”

Ophthalmic Manifestations of Acute Leukaemias

“…loidní leukémie se vyskytuje častěji v dospělém věku, nárůst incidence pozorujeme u pacientů nad 65 let [12,18,19].…”

Retinal neovascularization and vitreous haemorrhage in a patient with acute myeloid leukaemia and haematopoietic stem cell transplantation

“…Retinal abnormalities such as retinal haemorrhages and cotton‐wool spots are frequently observed in adult patients with acute myeloid leukaemia (Specchia et al 2001). Retinal neovascularization has been described in patients with chronic myelocytic and acute lymphocytic leukaemia (Wiznia et al 1994).…”