Genetic alteration patterns and clinical outcomes of elderly and secondary acute myeloid leukemia

• Published in: Hematological oncology 2019-10, Vol.37 (4), p.456-463
• Main Authors: Wang, Shi‐Yang, Cheng, Wen‐Yan, Mao, Yuan‐Fei, Zhu, Yong‐Mei, Liu, Fu‐Jia, Ma, Ting‐Ting, Shen, Yang
• Format: Article
• Language: English
• Subjects: Acute myeloid leukemia; Adolescent; Adult; Age Factors; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bone marrow; Bone Marrow - pathology; Cell death; Chromosome Aberrations; elderly; Female; Genes, Neoplasm; genetic; Geriatrics; Hematopoietic stem cells; Humans; Kaplan-Meier Estimate; Leukemia; Leukemia, Myeloid, Acute - drug therapy; Leukemia, Myeloid, Acute - genetics; Leukemia, Myeloid, Acute - pathology; Leukocyte Count; Leukocytes; Male; Medical prognosis; Middle Aged; Multivariate analysis; Mutation; Myeloid leukemia; Neoplasm, Residual; Neoplasms, Second Primary - drug therapy; Neoplasms, Second Primary - genetics; Neoplasms, Second Primary - pathology; Neoplastic Stem Cells - pathology; Older people; Original; Original s; Patients; Prognosis; Progression-Free Survival; Remission; Remission Induction; Risk analysis; Risk factors; secondary; Stem cell transplantation; Stem cells; Survival; Transplantation; Treatment Outcome; Young Adult
• ISSN: 0278-0232; 1099-1069
• DOI: 10.1002/hon.2656

To illustrate the clinical and genetic features of elderly and secondary acute myeloid leukemia (AML) patients, we compared 145 elderly AML (e‐AML) and 55 secondary AML (s‐AML) patients with 451 young de novo AML patients. Both e‐AML and s‐AML patients showed lower white blood cell (WBC) and bone marrow (BM) blasts at diagnosis. NPM1, DNMT3A, and IDH2 mutations were more common while biallelic CEBPA and IDH1 mutations were less seen in e‐AML patients. s‐AML patients carried a higher frequency of KMT2A‐AF9. In treatment response and survival, e/s‐AML conferred a lower complete remission (CR) rate and shorter duration of event‐free survival (EFS) and overall survival (OS) compared with young patients. In multivariate analysis, s‐AML was an independent risk factor for OS but not EFS in the whole cohort. Importantly, intensive therapy tended to improve the survival of e/s‐AML patients without increasing the risk of early death, and hematopoietic stem cell transplantation (HSCT) could rescue the prognosis of s‐AML, which should be recommended for the treatment of fit patients.