title: Poor response to intensive chemotherapy in de novo acute myeloid leukaemia with trilineage myelodysplasia. Japan Adult Leukaemia Study Group (JALSG).
abstract: The findings of morphologically dysplastic features in haemopoietic cells in de novo acute myeloid leukaemia (AML) has been named AML with trilineage myelodysplasia (AML/TMDS). We analysed the clinical data, karyotypes, and treatment outcomes of 230 de novo AML patients treated with the Japan Adult Leukaemia Study Group AML-87 protocol. 40 (17%) patients had AML/TMDS. Platelet count was significantly higher (P = 0.006) and bone marrow blasts were fewer (P = 0.01) in the AML/TMDS group than in the AML without TMDS. Abnormal karyotype was shown in 12/30 patients (40%) analysed. The complete remission (CR) rate for AML/TMDS was significantly lower than AML without TMDS (63% v 81%) (P = 0.01). The overall survival curves showed that the 40 patients with TMDS had a significantly worse survival than the 190 without TMDS (P = 0.0005). AML/TMDS also showed significantly worse disease-free survival (DFS) (P = 0.0001). Multivariate analysis revealed that the absence of TMDS in AML was the most significant factor in obtaining CR (P = 0.01) and a significant factor in predicting longer DFS (P = 0.04). Our data suggest that AML/TMDS responds poorly to intensive chemotherapy. Further study is required to determine the best treatment strategy for AML/TMDS and the biological differences between AML/TMDS and other types of AML.
authors.affiliation: Department of Haematology, Nagasaki University School of Medicine, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Kuriyama
authors.forename: M
authors.initials: M
authors.lastname: Tomonaga
authors.forename: T
authors.initials: T
authors.lastname: Matsuo
authors.forename: T
authors.initials: T
authors.lastname: Kobayashi
authors.forename: H
authors.initials: H
authors.lastname: Miwa
authors.forename: S
authors.initials: S
authors.lastname: Shirakawa
authors.forename: M
authors.initials: M
authors.lastname: Tanimoto
authors.forename: K
authors.initials: K
authors.lastname: Adachi
authors.forename: N
authors.initials: N
authors.lastname: Emi
authors.forename: A
authors.initials: A
authors.lastname: Hiraoka
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007621:Karyotyping; D007951:Leukemia, Myeloid / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome