Multilineage dysplasia (MLD) in acute myeloid leukemia (AML) correlates with MDS-related cytogenetic abnormalities and a prior history of MDS or MDS/MPN but has no independent prognostic relevance: a comparison of 408 cases classified as "AML not otherwise specified" (AML-NOS) or "AML with myelodysplasia-related changes" (AML-MRC)
Multilineage dysplasia (MLD) in acute myeloid leukemia (AML) correlates with MDS-related cytogenetic abnormalities and a prior history of MDS or MDS/MPN but has no independent prognostic relevance: a comparison of 408 cases classified as "AML not otherwise specified" (AML-NOS) or "AML with myelodysplasia-related changes" (AML-MRC)
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DOI：
10.1182/blood-2010-04-279794
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发表时间：
2010-10-14
期刊：
影响因子：
20.3
通讯作者：
Haferlach, Torsten
中科院分区：
文献类型：
--
作者：
Miesner, Miriam;Haferlach, Claudia;Haferlach, Torsten
世界卫生组织对急性髓细胞白血病（AML）的分类是分层结构的，并整合了遗传学、患者病史数据和多系发育不良（MLD）。“伴有骨髓增生异常综合征（MDS）相关变化的AML”（AML-MRC）类别与“未另行说明的AML”（AML-NOS）类别根据是否存在MLD、MDS相关细胞遗传学或MDS或MDS/骨髓增生性肿瘤（MPN）病史进行区分。我们分析了408例AML-MRC或AML-NOS成人患者。3年无事件生存期（EFS;中位数，13.8 vs 16.0个月）和3年总生存期（OS; 45.8% vs 53.9%）在MLD患者与无MLD患者之间无显著差异。然而，MLD与既存MDS（P <0.001）和MDS相关细胞遗传学（P = 0.035）相关。以MLD作为唯一AML-MRC标准的患者（AML-MLD-sole; n = 90）与AML-NOS（n = 232）相比，FLT 3内部串联重复频率较低（P = 0.032），中位年龄较低。首先，合并AML-MLD的AML-NOS患者（n = 323）的3年EFS（16.9 vs 10.7个月; P = 0.005）和3年OS（55.8% vs 32.5%; P = 0.001）优于有MDS或MDS/MPN或MDS相关细胞遗传学病史的患者（n = 85）。基因表达分析显示，与MDS相关细胞遗传学或MDS病史相关的AML相比，AML-MLD-sole与AML-NOS的组合具有不同的聚类。因此，单独的MLD没有显示出独立的临床效应，而细胞遗传学和MDS病史具有显著相关性。（血。2010;116（15）：2742-2751）
The World Health Organization classification of acute myeloid leukemia (AML) is hierarchically structured and integrates genetics, data on patients' history, and multilineage dysplasia (MLD). The category "AML with myelodysplastic syndrome (MDS)related changes" (AML-MRC) is separated from "AML not otherwise specified" (AML-NOS) by presence of MLD, MDS-related cytogenetics, or history of MDS or MDS/myeloproliferative neoplasm (MPN). We analyzed 408 adult patients categorized as AML-MRC or AML-NOS. Three-year event-free survival (EFS; median, 13.8 vs 16.0 months) and 3-year overall survival (OS; 45.8% vs 53.9%) did not differ significantly between patients with MLD versus without. However, MLD correlated with preexisting MDS (P < .001) and MDS-related cytogenetics (P = .035). Patients with MLD as sole AML-MRC criterion (AML-MLD-sole; n = 90) had less frequently FLT3 internal tandem duplication (P = .032) and lower median age than AML-NOS (n = 232). Contrarily, patients with AML-NOS combined with AML-MLD-sole (n = 323) had better 3-year EFS (16.9 vs 10.7 months; P = .005) and 3-year OS (55.8% vs 32.5%; P = .001) than patients with history of MDS or MDS/MPN or MDS-related cytogenetics (n = 85). Gene expression analysis showed distinct clusters for AML-MLD-sole combined with AML-NOS versus AML with MDS-related cytogenetics or MDS history. Thus, MLD alone showed no independent clinical effect, whereas cytogenetics and MDS history were prognostically relevant. (Blood. 2010;116(15):2742-2751)