Myeloid Leukemia with Myelodysplasia-Related Changes Was Not a Prognostic Factor Under Allogenic Hematopoietic Stem Cell Transplantation

Abstract

Introduction and Objectives Acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) is briefly defined as an AML which have multilineage dysplasia (MLD), a history of myelodysplastic syndrome (MDS) and/or an MDS-related cytogenetic abnormalities. Recent study showed that AML-MRC exhibits a worse clinical outcome than AML not otherwise specified (AML-NOS). Though allogenic hematopoietic stem cell transplantation (allo-SCT) is believed to improve the outcome of AML-MRC, few reports had referred to its benefit. The purpose of this study was to clarify the outcome and the prognostic factors of patients (pts) with AML-MRC who underwent allo-SCT. Methods Between January 2008 to December 2017, a total of 138 consecutive AML-MRC (n = 50) and AML-NOS (n = 88) pts who underwent allo-SCT in Japanese Red Cross Nagoya Daiichi Hospital were retrospectively analyzed. The classifications of diagnoses were made according to the criteria of the 2008 WHO classification and data of clinical, pathologic and cytogenetic features were collected. Results Among 138 pts, the median age at SCT was 45.5 years (range, 17 to 66 years), and 59 (43%) pts were female. Performance status was 2-4 for 7 (5%) pts and HCT-CI was ≧3 for 14 (10%) pts. The cytogenetic features were classified as intermediate risk for 78 (57%) pts and high or unknown risk for 60 (43%) pts according to the Southwest Oncology Group (SWOG) criteria. Ninety-five (69%) pts were in complete remission (CR) at SCT. Twenty-four (17%) pts had related donor and 71 (51%), 31 (22%), and 36 (26%) pts received bone marrow, peripheral blood stem cell, and cord blood, respectively. Myeloablative conditioning was performed in 87 (63%) pts. The median follow-up period for survivors was 51 months (range, 3 to 108 months). Compared to AML-NOS pts, pts with AML-MRC had significantly low frequency of CR at SCT (48% vs 81%, p Subgroup analysis was performed and SWOG high risk cytogenetics was identified as independent prognostic factor in the pts with AML-NOS (HR 2.31, p = 0.01). Among pts with AML-MRC, MDS-related cytogenetics (HR 4.52, p Conclusion Here we show that cytogenetic features, but not a diagnosis of AML-MRC, is one of the most important prognostic factors when performing allo-SCT,