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. 2023 Aug;12(16):16929-16944.
doi: 10.1002/cam4.6322. Epub 2023 Aug 7.

Clinical outcome of therapy-related acute myeloid leukemia patients. Real-life experience in a University Hospital and a Cancer Center in France

Amine Belhabri  1 , Mael Heiblig  2 , Stephane Morisset  3 , Liliana Vila  1 , Clémence Santana  1 , Emmanuelle Nicolas-Virelizier  1 , Sandrine Hayette  4 , Isabelle Tigaud  4 , Adriana Plesa  4 , Hélène Labussiere-Wallet  2 , Mohamad Sobh  5 , Anne-Sophie Michallet  1 , Balsat Marie  2 , Franck-Emmanuel Nicolini  1 , Yann Guillermin  1 , Fossard Gaëlle  2 , Laure Lebras  1 , Philippe Rey  1 , Lucie Jauffret-Bertholon  1 , Marie-Charlotte Laude  1 , Loron Sandrine  2 , Mauricette Michallet  1
Affiliations

Clinical outcome of therapy-related acute myeloid leukemia patients. Real-life experience in a University Hospital and a Cancer Center in France

Amine Belhabri et al. Cancer Med. 2023 Aug.

Abstract

Background: t-AML occurs after a primary malignancy treatment and retains a poor prognosis.

Aims: To determine the impact of primary malignancies, therapeutic strategies, and prognostic factors on clinical outcomes of t-AML.

Results: A total of 112 adult patients were included in this study. Fifty-Five patients received intensive chemotherapy (IC), 33 non-IC, and 24 best supportive care. At t-AML diagnosis, 42% and 44% of patients presented an unfavorable karyotype and unfavorable 2010 ELN risk profile, respectively. Among treated patients (n = 88), 43 (49%) achieved complete remission: four out of 33 (12%) and 39 out of 55 (71%) in non-IC and IC groups, respectively. With a median follow-up of 5.5 months, the median overall survival (OS) and disease-free survival (DFS) for the whole population were 9 months and 6.3 months, respectively, and for the 88 treated patients 13.5 months and 8.2 months, respectively. Univariate analysis on OS and DFS showed a significant impact of high white blood cells (WBC) and blast counts at diagnosis, unfavorable karyotype and ELN classification. Multivariate analysis showed a negative impact of WBC count at diagnosis and a positive impact of chemotherapy on OS and DFS in the whole population. It also showed a negative impact of previous auto-HCT and high WBC count on OS and DFS and of IC on OS in treated patients which disappeared when we considered only confounding variables (age, previous cancers, marrow blasts, and 2010 ELN classification). In a pair-matched analysis comparing IC treated t-AML with de novo AML, there was no difference of OS and DFS between the two populations.

Conclusion: We showed, in this study that t-AML patients with unfavorable features represented almost half of the population. Best outcomes obtained in patients receiving IC must be balanced by known confounding variables and should be improved by using new innovative agents and therapeutic strategies.

Keywords: clinical outcome; real-life management; therapy-related AML.

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Conflict of interest statement

The authors do not declare any conflict of interest.

Figures

FIGURE 1
FIGURE 1
Kaplan Meier curves evaluatiing OS and DFS (A) OS of whole population, (B) DFS of treated population, (C) OS of whole population according to treatment groups, (D) DFS of treated population according to treatment intensity.
FIGURE 2
FIGURE 2
Kaplan‐Meier curves evaluatiing OS and DFS according to 2010 ELN classification (A) OS of whole population, (B) DFS of treated population.
FIGURE 3
FIGURE 3
Cumulative incidence of relapse in treated population.
FIGURE 4
FIGURE 4
Kaplan‐Meier curves evaluating OS and DFS of pair‐matched populations (IC treated AML vs de novo AML), (A) OS of t‐AML and matched de novo AML, (B) DFS of t‐AML and matched de novo AML.
FIGURE 5
FIGURE 5
Cumulative incidence of relapse of pair‐matched populations.
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