Risk factors and clinical outcomes of acute myeloid leukaemia with central nervous system involvement in adults

Chieh-Lung Cheng¹, Chi-Cheng Li², Hsin-An Hou³, Wei-Quan Fang⁴, Chin-Hao Chang⁵, Chien-Ting Lin⁶, Jih-Luh Tang⁷, Wen-Chien Chou^{8

9}, Chien-Yuan Chen¹⁰, Ming Yao¹¹, Shang-Yi Huang¹², Bor-Sheng Ko¹³, Shang-Ju Wu¹⁴, Woei Tsay¹⁵, Hwei-Fang Tien¹⁶

Affiliations

¹ Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. meteor.prince@msa.hinet.net.
² Taicheng stem cell therapy center, National Taiwan University, Taipei, Taiwan. kevinlcc1234@gmail.com.
³ Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. hsinanhou@gmail.com.
⁴ Taiwan Clinical Trial Bioinformatics and Statistical Center, Training Center, and Pharmacogenomics Laboratory, Taipei, Taiwan. wqfang@ntu.edu.tw.
⁵ Department of Medical Research, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. chinhao@ntuh.gov.tw.
⁶ Taicheng stem cell therapy center, National Taiwan University, Taipei, Taiwan. antony.lin@ylhealth.org.
⁷ Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. tangjh@ntu.edu.tw.
⁸ Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. wchou@ntu.edu.tw.
⁹ Department of Laboratory Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. wchou@ntu.edu.tw.
¹⁰ Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. cjy5988@yahoo.com.tw.
¹¹ Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. yaoming@ntu.edu.tw.
¹² Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. sy551225@ms7.hinet.net.
¹³ Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. kevinkomd@gmail.com.
¹⁴ Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. no_bighead@yahoo.com.tw.
¹⁵ Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. woei@ntuh.gov.tw.
¹⁶ Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. hftien@ntu.edu.tw.

PMID: 25934556
PMCID: PMC4419415
DOI: 10.1186/s12885-015-1376-9

Risk factors and clinical outcomes of acute myeloid leukaemia with central nervous system involvement in adults

Chieh-Lung Cheng et al. BMC Cancer. 2015.

. 2015 May 2:15:344.

doi: 10.1186/s12885-015-1376-9.

Authors

Affiliations

¹ Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. meteor.prince@msa.hinet.net.
² Taicheng stem cell therapy center, National Taiwan University, Taipei, Taiwan. kevinlcc1234@gmail.com.
³ Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. hsinanhou@gmail.com.
⁴ Taiwan Clinical Trial Bioinformatics and Statistical Center, Training Center, and Pharmacogenomics Laboratory, Taipei, Taiwan. wqfang@ntu.edu.tw.
⁵ Department of Medical Research, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. chinhao@ntuh.gov.tw.
⁶ Taicheng stem cell therapy center, National Taiwan University, Taipei, Taiwan. antony.lin@ylhealth.org.
⁷ Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. tangjh@ntu.edu.tw.
⁸ Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. wchou@ntu.edu.tw.
⁹ Department of Laboratory Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. wchou@ntu.edu.tw.
¹⁰ Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. cjy5988@yahoo.com.tw.
¹¹ Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. yaoming@ntu.edu.tw.
¹² Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. sy551225@ms7.hinet.net.
¹³ Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. kevinkomd@gmail.com.
¹⁴ Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. no_bighead@yahoo.com.tw.
¹⁵ Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. woei@ntuh.gov.tw.
¹⁶ Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. hftien@ntu.edu.tw.

PMID: 25934556
PMCID: PMC4419415
DOI: 10.1186/s12885-015-1376-9

Abstract

Background: Acute myeloid leukaemia (AML) with central nervous system (CNS) involvement in adults is uncommon, and studies of this subject are scant.

Methods: We conducted a retrospective study to investigate the clinical aspects, cytogenetic abnormalities, molecular gene mutations and outcomes of adult AML patients with CNS involvement. Three hundred and ninety-five patients with newly diagnosed AML were reviewed.

Results: Twenty (5.1%) patients had CNS involvement, including 7 (1.8%) with initial CNS disease and 4 (1%) who suffered an isolated CNS relapse. The patients with CNS involvement were younger, had higher leukocyte, platelet, and peripheral blast cell counts, FAB M4 morphology, and chromosome translocations involving 11q23 (11q23 abnormalities) more frequently than did the patients without CNS involvement. No differences in sex, haemoglobin levels, serum LDH levels, immunophenotype of leukaemia cells, or molecular gene mutations were observed between the two groups. Multivariate analyses showed that age ≤ 45 years (OR, 5.933; 95% CI, 1.82 to 19.343), leukocyte counts ≥ 50,000/μl (OR, 3.136; 95% CI, 1.083 to 9.078), and the presence of 11q23 abnormalities (OR, 5.548; 95% CI, 1.208 to 25.489) were significant predictors of CNS involvement. Patients with initial CNS disease had 5-year overall survival and relapse-free survival rates that were similar to those without initial CNS disease. However, three of four patients who suffered an isolated CNS relapse died, and their prognosis was as poor as that of patients who suffered a bone marrow relapse.

Conclusion: CNS involvement in adult patients with AML is rare. Three significant risk factors for CNS involvement including age ≤ 45 years, leukocyte counts ≥ 50,000/μl and the presence of 11q23 abnormalities were identified in this study. Future investigations to determine whether adult AML patients having these specific risk factors would benefit from CNS prophylactic therapy are necessary.

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Figures

**Figure 1**
Kaplan-Meier curves for overall survival **(A)** and relapse-free survival **(B)** of AML patients ≥ 18 years of age stratified based their status of CNS involvement at diagnosis. Only those receiving conventional standard chemotherapy were included in the survival analyses.

**Figure 2**
Kaplan-Meier curves for overall survival of AML patients ≥ 18 years of age with an isolated CNS relapse or a bone marrow relapse.

See this image and copyright information in PMC

References

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Risk factors and clinical outcomes of acute myeloid leukaemia with central nervous system involvement in adults

Affiliations

Risk factors and clinical outcomes of acute myeloid leukaemia with central nervous system involvement in adults

Authors

Affiliations

Abstract

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Medical

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