Similarly Dismal Outcomes of AML After an Antecedent Hematologic Disorder and Therapy Related AML

Therapy related acute myeloid leukemia (tAML) and secondary AML after an antecedent hematologic disorder (sAML-AHD) are often addressed together, blurring any clinical and prognostic differences. Among 516 AML patients, we compared characteristics and outcomes of 149 patients with sAML. Both sAML groups have inferior outcomes after chemotherapy. By multivariate analysis, alloHCT was an independent predictor of outcome in both groups, while karyotype was for sAML-AHD only. Therapy related acute myeloid leukemia (tAML) and secondary AML after an antecedent hematologic disorder (sAMLAHD) are often addressed together, blurring any clinical and prognostic differences. Among 516 AML patients, we compared characteristics and outcomes of 149 patients with sAML (sAML-AHD: 104, tAML: 45), uniformly and intensively treated during the last 2 decades at 1 center. Clinical outcomes of the whole sAML cohort were significantly inferior compared to de novo AML and in both intermediate and poor cytogenetic risk groups. Adverse karyotype had no effect on survival in tAML, while it was a negative predictor in sAML-AHD. Both groups showed similarly dismal outcome, with low complete remission rates (CR 44% vs. 41%) and median overall survival (OS 7 vs. 10.5 months). Allogeneic hematopoietic cell transplantation (alloHCT) recipients in CR1 had superior median OS (24 vs. 8 months). By multivariate analysis, alloHCT was an independent predictor of outcome, while karyotype was for sAML-AHD only. In conclusion, both sAML groups have inferior outcomes after chemotherapy, with adverse karyotype affecting pr imar ily sAML-AHD. Until new treatment approaches are available, only alloHCT offers a survival advantage.

Automated summary

Therapy related acute myeloid leukemia (tAML) and secondary AML after an antecedent hematologic disorder (sAML-AHD) are often considered together, although they have some clinical and prognostic differences. Both sAML groups have poor outcomes after uniform and intensive treatment. Allogeneic hematopoietic cell transplantation (alloHCT) was found to be an independent predictor of outcome in both groups, while karyotype only affected sAML-AHD.