Acute Myeloid Leukemia with t(v;5q33-34) Does Not Always have Myelodysplastic Features but is Associated with Poor Outcome

Abstract

conducted a retrospective analysis of BCA patients who developed t-MN seen at The University of Texas MD Anderson Cancer Center between January 1997 and April 2013. As defined in the WHO classification, t-MN includes therapyrelated acute myeloid leukemia (t-AML), myelodysplastic syndrome (t-MDS), and myelodysplastic/myeloproliferative neoplasms (t-MDS/MPN). The study inclusion criteria included receipt of neoadjuvant or adjuvant chemotherapy and/or radiation therapy for BCA with subsequent development of t-MN. Results: Patients (n1⁄4150) were women with a median age of 57 years (range, 26-79 years) at the time of BCA diagnosis (64 at time of t-MN; range, 29-84 years). In addition to surgery, 93 (62%) patients were treated with combination chemotherapy and radiation therapy, 30 (20%) with radiation therapy alone, and 27 (18%) with chemotherapy alone. The median interval between BCA and t-MN was 57 months (range, 8-374 months). At presentation with t-MN, 90 (60%) patients had t-AML, 56 (37%) t-MDS, and 4 (3%) t-MDS/MPN. Among all patients with tMN, those with MLL gene (11q23) rearrangement had a worse overall survival (OS) (p1⁄40.017) while those with favorable recurrent chromosomal translocations (PML/RARA; CBFBMYH11; RUNX1/RUNX1T1) had a better OS (p1⁄40.001). Patients who received allogeneic stem-cell transplant (SCT) (n1⁄436) for t-MN had a better OS calculated from the onset of t-MN compared to those who did not (p1⁄40.018). Factors associated independently with OS calculated from the time of BCA diagnosis included age at BCA diagnosis (p<0.001), chemotherapy for BCA (p1⁄40.027), and growth factor administration (p1⁄40.023). Factors associated independently with OS calculated from the time of tMN diagnosis included MLL rearrangement (p1⁄40.014), favorable recurrent balanced translocations (p1⁄40.006), and SCT (p1⁄40.010). Conclusions: MLL gene rearrangements and balanced chromosomal translocations retain their relative prognostic impact in patients with BCA who develop t-MN. Such patients appear to benefit from allogeneic SCT.