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Clinical Trial
. 2011 Feb 17;117(7):2137-45.
doi: 10.1182/blood-2010-08-301713. Epub 2010 Dec 2.

The impact of therapy-related acute myeloid leukemia (AML) on outcome in 2853 adult patients with newly diagnosed AML

Sabine Kayser  1 , Konstanze Döhner, Jürgen Krauter, Claus-Henning Köhne, Heinz A Horst, Gerhard Held, Marie von Lilienfeld-Toal, Sibylla Wilhelm, Andrea Kündgen, Katharina Götze, Mathias Rummel, David Nachbaur, Brigitte Schlegelberger, Gudrun Göhring, Daniela Späth, Carina Morlok, Manuela Zucknick, Arnold Ganser, Hartmut Döhner, Richard F Schlenk; German-Austrian AMLSG
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Free article
Clinical Trial

The impact of therapy-related acute myeloid leukemia (AML) on outcome in 2853 adult patients with newly diagnosed AML

Sabine Kayser et al. Blood. .
Free article

Abstract

To study the characteristics and clinical impact of therapy-related acute myeloid leukemia (t-AML). 200 patients (7.0%) had t-AML and 2653 de novo AML (93%). Patients with t-AML were older (P < .0001) and they had lower white blood counts (P = .003) compared with de novo AML patients; t-AML patients had abnormal cytogenetics more frequently, with overrepresentation of 11q23 translocations as well as adverse cytogenetics, including complex and monosomal karyotypes, and with underrepresentation of intermediate-risk karyotypes (P < .0001); t-AML patients had NPM1 mutations (P < .0001) and FLT3 internal tandem duplications (P = .0005) less frequently. Younger age at diagnosis of primary malignancy and treatment with intercalating agents as well as topoisomerase II inhibitors were associated with shorter latency periods to the occurrence of t-AML. In multivariable analyses, t-AML was an adverse prognostic factor for death in complete remission but not relapse in younger intensively treated patients (P < .0001 and P = .39, respectively), relapse but not death in complete remission in older, less intensively treated patients (P = .02 and P = .22, respectively) and overall survival in younger intensively treated patients (P = .01). In more intensively treated younger adults, treatment-related toxicity had a major negative impact on outcome, possibly reflecting cumulative toxicity of cancer treatment.

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