Characteristics and outcomes of patients with therapy-related acute myeloid leukemia with normal karyotype
Bachar Samra, Guillaume Richard‐Carpentier, Tapan M. Kadia, Farhad Ravandi, Naval Daver, Courtney D. DiNardo, Ghayas C. Issa, Prithviraj Bose, Marina Konopleva, Musa Yılmaz, Maro Ohanian, Gautam Borthakur, Guillermo Garcia‐Manero, Sherry Pierce, Jörge E. Cortes, Hagop M. Kantarjian, Nicholas J. Short
Abstract
Normal karyotype in therapy-related acute myeloid leukemia (t-AML) is rare and the relative contribution of prior exposure to chemotherapy or radiotherapy to outcomes in these patients remains uncertain. We performed a retrospective study of 742 patients with newly diagnosed AML and normal karyotype (t-AML, n = 61, and non-t-AML, n = 681). Patients with t-AML were older but had a similar mutational profile compared to those with non-t-AML. Overall survival (OS) and relapse-free survival (RFS) were significantly worse for patients with t-AML (P < 0.01 and P = 0.02, respectively). Patients with t-AML had a higher cumulative incidence of death in remission (51% versus 16%, P < 0.01), but not higher cumulative incidence of relapse (42% versus 56%, respectively, P = 0.21). Both intensive induction and allogeneic hematopoietic stem cell transplantation in first remission were associated with improved OS and RFS in non-t-AML but not in t-AML. Overall, although disease biology appears similar between t-AML and non-t-AML with normal karyotype as indicated by similar risks of relapse, death in remission is the main driver of inferior outcome in t-AML. Careful therapeutic decisions are required to mitigate potential treatment-related toxicity in this rare subgroup of patients with t-AML and normal karyotype.