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Annals of Oncology Advance Access originally published online on May 10, 2006
Annals of Oncology 2006 17(7):1146-1151; doi:10.1093/annonc/mdl083
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© 2006 European Society for Medical Oncology

An antecedent diagnosis of refractory anemia with excess blasts has no prognostic relevance in acute myeloid leukemia of older adult patients

S. Palmieri1, A. M. D'Arco2, M. Celentano1, G. Mele1, C. Califano2, F. Pollio1, M. R. D'Amico1 and F. Ferrara1,*

1 Division of Hematology and Stem Cell Transplantation Unit, Cardarelli Hospital, Naples; 2 Division of Onco-Hematology, Umberto I Hospital, Nocera Inferiore, Italy

* Correspondence to: Dr F. Ferrara, Via Niccolò Piccinni 6, 80128 Napoli, Italy. Tel: +39-0817472241; Fax: +39-0817472241; E-mail: felicettoferrara{at}katamail.com

Background: Conflicting results have been reported about the prognostic relevance of antecedent myelodysplastic syndrome (MDS) in acute myeloid leukemia (AML) of older adults.

Patients and methods: Data from 87 intensively treated AML patients (median age 69 years) were analyzed, with the aim of comparing therapeutic results and toxicity between de novo and AML secondary to a previous MDS (s-AML). Rate of CD34+ cells mobilization and feasibility of autologous stem cell transplantation (ASCT) were also compared.

Results: Complete remission rate, death in induction and primary resistance were not statistically different between the two groups. Median time for neutrophil recovery was similar, while s-AML patients required a longer time for platelet recovery (P = 0.04). There was no difference as to eligibility for consolidation as well as for mobilization and feasibility of ASCT. S-AML had negligible impact on overall survival (OS) and disease-free survival (DFS). In the multivariate analysis the only parameter significantly related to either OS or DFS duration was adverse karyotype (P = 0.02 and 0.04, respectively).

Conclusions: A diagnosis of s-AML does not represent a clinically relevant prognostic factor in elderly AML patients treated with aggressive therapy. Furthermore, s-AML patients can be mobilized and autografted with comparable results as opposed to de novo cases.

Key words: acute myeloid leukemia, elderly patients, antecedent MDS, prognostic relevance


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