title: Prognostic model to identify patients with myelofibrosis at the highest risk of transformation to acute myeloid leukemia.
abstract: BACKGROUND
  Some patients with myelofibrosis (MF) progress to acute myeloid leukemia (AML). Current prognostic tools were not devised to assess risk of AML transformation.
  
  
  METHODS
  Multivariate analysis in 649 patients followed for a median of 19 months (range, 1-180 months).
  
  
  RESULTS
  We identified age > 60 (P = .004; hazard ratio [HR], 1.63), platelets <100 × 10(9)/L (P < .001; HR, 1.62), bone marrow blast > 10% (P = .002; HR, 2.18), high-risk karyotype (P < .001; HR, 2.44), transfusion dependency (P < .001; HR, 2.64), performance status > 1 (P = .003; HR, 1.47), lactate dehydrogenase > 2000 U/L (P < .001; HR, 1.62), previous hydroxyurea (P < .001; HR, 1.69), and male sex (P = .005; HR, 1.41) as independent poor prognostic factors for survival. Using the same baseline variables we identified bone marrow blasts >10% and worst karyotype as independent risk factors for AML transformation. Patients with 1 or both of these risk factors (n = 80; 12%) had a median survival of 10 months and a 1-year AML transformation rate of 13% (2% if none of those factors, P = .001).
  
  
  CONCLUSIONS
  We have identified risk factors that predict high risk of transformation from MF to AML.
authors: Department of Leukemia, M.D. Anderson Cancer Center, Houston, TX 77030, USA. aquintas@mdanderson.org
authors: Alfonso
authors: A
authors: Quintás-Cardama
authors: Hagop
authors: H
authors: Kantarjian
authors: Sherry
authors: S
authors: Pierce
authors: Jorge
authors: J
authors: Cortes
authors: Srdan
authors: S
authors: Verstovsek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002471:Cell Transformation, Neoplastic / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000453:epidemiology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D055728:Primary Myelofibrosis / Q000453:epidemiology* / Q000473:pathology*; D011379:Prognosis; D016019:Survival Analysis; D055815:Young Adult
references: Blood. 2009 Mar 26;113(13):2895-901
references: 18988864
references: Blood. 2011 Aug 18;118(7):1723-35
references: 21653328
references: J Clin Oncol. 2011 Jun 10;29(17):2410-5
references: 21537037
references: Blood. 2005 Feb 1;105(3):973-7
references: 15388582
references: Blood. 2011 Oct 27;118(17):4595-8
references: 21881047
references: South Med J. 1987 Mar;80(3):323-7
references: 3824016
references: Blood. 2012 May 10;119(19):4480-5
references: 22431577
references: Leukemia. 2012 Jun;26(6):1439-41
references: 22289985
references: Blood. 2010 Nov 11;116(19):3735-42
references: 20664061
references: Int J Hematol. 2001 Feb;73(2):194-8
references: 11372731
references: J Clin Oncol. 2009 Nov 20;27(33):5587-93
references: 19786661
references: Nat Rev Cancer. 2012 Sep;12(9):599-612
references: 22898539
references: Blood. 2005 Apr 1;105(7):2664-70
references: 15585653
references: Leuk Lymphoma. 2000 Apr;37(3-4):379-85
references: 10752989
references: Blood. 2010 Mar 4;115(9):1703-8
references: 20008785
references: Br J Haematol. 2000 Sep;110(3):577-83
references: 10997967
references: J Clin Oncol. 2011 Feb 1;29(4):392-7
references: 21149668