title: Risk assessment in human immunodeficiency virus-associated acute myeloid leukemia.
abstract: CD4 count ≤200×10(6) cells/L has been identified as a predictor of short survival in HIV-associated acute myeloid leukemia (HIV-AML), but karyotype, which is the best predictor of survival in AML, has not been evaluated in HIV-AML patients. A retrospective cohort of 31 patients was created from 9 local cases and 22 published cases. HIV-AML karyotypes were heterogeneous and were similar in distribution to those in HIV-negative AML. Among intensively treated patients, most achieved complete remission, but succumbed to infectious complications, mostly non-opportunistic, during consolidation therapy. Median survival for intensively-treated patients with CD4 counts ≤200×10(6) cells/L was 8.5 months, compared to 48 months for those with >200×10(6) CD4 cells/L (p=0.03). In contrast, AML karyotype did not predict survival (p=0.43), albeit with small numbers in each karyotype group. Thus, CD4 count is a strong predictor of short survival in HIV-AML patients regardless of karyotype. Studies evaluating innovative strategies for infection prophylaxis and for improving immune reconstitution are needed.
authors.affiliation: University of Maryland Greenebaum Cancer Center, Baltimore, MD 21201, USA. evans.mike@gmail.com
authors.forename: Michael W
authors.initials: MW
authors.lastname: Evans
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Sung
authors.forename: Ivana
authors.initials: I
authors.lastname: Gojo
authors.forename: Michael
authors.initials: M
authors.lastname: Tidwell
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Greer
authors.forename: Mark
authors.initials: M
authors.lastname: Levis
authors.forename: Judith
authors.initials: J
authors.lastname: Karp
authors.forename: Maria R
authors.initials: MR
authors.lastname: Baer
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000150:complications* / Q000821:virology; D006801:Humans; D059785:Karyotype; D007951:Leukemia, Myeloid / Q000188:drug therapy* / Q000235:genetics / Q000276:immunology; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult