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).
|AML-C n=15||AML-N n=41||P-value|
|Median age (years)||79||65||0.004|
|Diagnosed as AML-MRC||11/15||14/41||0.01|
|Morphologic dysplasia in any lineage||11/15||18/41||0.07|
|Median overall survival (months)||3||12||0.005|
|Median survival (months), age >70||2||10||0.0003|
|Median survival (months), intermediate risk karyotypes||3||14||0.06|