title: Reasons for treating secondary AML as de novo AML.
abstract: In a Danish bi-regional registry-based study, we conducted an analysis of the incidence and clinical importance of secondary acute myeloid leukaemia (AML). In a total of 630 cases of AML, we found 157 (25%) cases of secondary AML. The secondary leukaemia arose from MDS (myelodysplastic syndrome) in 77 cases (49%), CMPD (chronic myeloproliferative disorder) in 43 cases (27%) and was therapy-related AML (t-AML) in 37 cases (24%). Median age at diagnosis of AML was 69 yr in secondary cases when compared to 66 yr in de novo cases (P = 0.006). In univariate analyses, secondary AML was associated with an inferior complete remission (CR) rate (P = 0.008) and poorer overall survival (OS, P = 0.003) whereas in complete remitters, disease-free survival (DFS) of secondary cases was equal to that of de novo cases. Interestingly, in all further analyses of CR-rates, OS and DFS, when correcting for the influence of age, cytogenetic abnormalities, performance status and leucocyte count (WBC), presence of secondary AML completely lost prognostic significance. We conclude that the presence of secondary AML does not per se convey an unfavourable prognosis and that patients with secondary AML should be offered the chance of benefiting from treatment according to current frontline AML protocols.
authors.affiliation: Department of Haematology, Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Lene Sofie Granfeldt
authors.initials: LS
authors.lastname: Ostgård
authors.forename: Eigil
authors.initials: E
authors.lastname: Kjeldsen
authors.forename: Mette Skov
authors.initials: MS
authors.lastname: Holm
authors.forename: Peter De Nully
authors.initials: Pde N
authors.lastname: Brown
authors.forename: Bjarne Bach
authors.initials: BB
authors.lastname: Pedersen
authors.forename: Knud
authors.initials: K
authors.lastname: Bendix
authors.forename: Preben
authors.initials: P
authors.lastname: Johansen
authors.forename: Jørgen Schøler
authors.initials: JS
authors.lastname: Kristensen
authors.forename: Jan Maxwell
authors.initials: JM
authors.lastname: Nørgaard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015331:Cohort Studies; D020732:Cytogenetic Analysis; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications* / Q000175:diagnosis; D012042:Registries; D055815:Young Adult