Abstract
BackgroundHypocellular acute myeloid leukemia (Hypo-AML) is a rare disease entity. Studies investigating the biological characteristics of hypo-AML have been largely lacking. We examined the clinical and biological characteristics, as well as treatment outcomes of hypo-AML in our institutes over a seven years period.Design and MethodsWe retrospectively analyzed data on 631 adult AML patients diagnosed according to the French-American-British (FAB) classification and WHO classification of tumors of haematopoietic and lymphoid tissue, including 43 patients with hypo-AML. Biological variables, treatment outcomes and follow-up data on hypo-AML patients were analyzed.ResultsOut of 631 AML patients, 47 (7.4%) were diagnosed as hypo-AML, out of which 43 patients were evaluable. Compared with non-hypocellular AML, hypo-AML patients tended to be older (P = 0.05), more likely to present with leukocytopenia (P < 0.01) and anterior hematological diseases (P = 0.02). The overall complete remission (CR) rate, disease free survival (DFS), and overall survival (OS) in hypo-AML patients were comparable to those in non-hypo AML patients. Twenty-seven (62.8%) patients with hypocellular AML were treated with the standard regimen of anthracyclines and cytarabine (XA) (associated CR rate: 51.9%; median OS: 7 months; median DFS: 6.5 months). Sixteen (37.2%) patients were treated with a priming regimen containing homoharringtonine, cytarabine and G-CSF (HAG) (associated CR rate: 81.25%; median OS: 16 months; median DFS: 16 months).ConclusionsThe overall prognosis of hypo-AML was not inferior to that of non-hypo AML. HAG regimen might increase response rates and improve survival in hypo-AML patients.
Highlights
While most cases of acute myeloid leukemia (AML)are hypercellular or normocellular, up to 5-12% of all cases are that of hypocellular AML (Hypo-AML).[1,2,3,4,5] The clinical course, diagnosis and management of nine cases of hypoplastic acute myelogeneous leukemia was www.impactjournals.com/oncotarget Hypo-AMLTotal patients (N) Female sex, N (%) Median age, y AHD, No (%)Median white blood cell (WBC) count, ×109/L 2.2 (0.2-64.4)Median HGB level, g/L 83 (30-142)Median platelet count, ×109/ L 51 (4-306)Median bone %(range) marrow cellularity, 14 (11-20)Median blasts in bone marrow (%) 43 (24-85)Non-hypo-AML 541 229 (42.3) 46 (15-78) 43 (8) 12.6 (0.5-247)
We examined the incidence of hypoAML and undertook a systematic analysis of the clinical and laboratory characteristics in AML patients
[9] it is remarkable that the frequency of hypoAML was comparable to that reported earlier (5-7%) using the criteria of bone marrow cellularity of 40-50% for labeling a case as that of hypo-AML
Summary
Are hypercellular or normocellular, up to 5-12% of all cases are that of hypocellular AML (Hypo-AML).[1,2,3,4,5] The clinical course, diagnosis and management of nine cases of hypoplastic acute myelogeneous leukemia was www.impactjournals.com/oncotarget. The treatment options for hypo-AML [9, 10], complete remission (CR) rates, overall survival (OS), duration of remission, and event-free survival (EFS) were found to be comparable to those of patients with non-hypocellular AML in a large study on 123 patients of hypo-AML and 1219 non-hypocellular AML. We undertook this study to assess the frequency of hypo-AML among a large Chinese cohort of patients with AML. We describe the clinical features of this group and compare their clinical outcomes with those of other patients with AML, to assess the impact of this pathologic feature on prognosis, and to evaluate the efficacy of different induction regimens
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