[1395] Cytopenia Prior to AML Diagnosis Predicts Aggressive Behavior Even in the Absence of Antecedent MDS: Another Diagnostic Criterion for AML with Myelodysplasia-Related Changes?

Amelia Huck, Amir Fathi, Robert Hasserjian. Massachusetts General Hospital, Boston, MA

Background: Acute myeloid leukemia (AML) is a heterogeneous disease with prognosis influenced by many factors, including age, karyotype, mutation status, and history of chemotherapy or myelodysplastic syndrome (MDS). AML with myelodysplasia-related changes (AML-MRC) has a poor prognosis compared to other AML subtypes. We hypothesized that patients with persistent (>6 months) cytopenia prior to AML diagnosis but without a prior diagnosis of MDS may also have an aggressive course, similar to AML-MRC.
Design: We evaluated 56 patients with AML who had complete blood count (CBC) data available at least 6 months prior to diagnosis. Patients with a history of cytotoxic therapy or any myeloid neoplasm were excluded. Cytopenia was defined as thrombocytopenia (<150,000/ul) or macrocytic anemia (hemoglobin<12 gm/dl and MCV>100 fl) that could not be attributed to comorbid conditions.
Results: 15/56 (27%) had cytopenia prior to AML diagnosis (AML-C). The median time between the CBC and AML diagnosis was 12 months and did not differ between the AML-C and non-cytopenic (AML-N) patients. There was no difference in the number of prior malignancies or other medical conditions between the two groups. The AML-C patients were significantly older and more often met criteria for AML-MRC compared to the AML-N patients. The AML-C patients also had inferior overall survival, even when restricting the analysis to patients >70. Among the patients with intermediate risk AML karyotype, AML-C patients had borderline inferior survival compared with AML-N patients (Table 1).

Table 1. Characteristics of AML-C and AML-N patients.
 AML-C n=15AML-N n=41P-value
Median age (years)79650.004
Abnormal karyotype12/1521/400.07
Diagnosed as AML-MRC11/1514/410.01
Morphologic dysplasia in any lineage11/1518/410.07
Prior malignancy3/157/41NS
Median overall survival (months)3120.005
Median survival (months), age >702100.0003
Median survival (months), intermediate risk karyotypes3140.06

Conclusions: AML patients with prior cytopenia have features similar to AML-MRC patients, including inferior survival and a high frequency of abnormal karyotypes. While these data must be confirmed in a larger cohort of patients, they suggest that a prior history of unexplained thrombocytopenia or macrocytic anemia could be considered as an additional criterion for AML-MRC, even without a documented prior MDS diagnosis.
Category: Hematopathology

Tuesday, March 5, 2013 8:00 AM

Proffered Papers: Section C, Tuesday Morning


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