title: Characterization and prognostic features of secondary acute myeloid leukemia in a population-based setting: a report from the Swedish Acute Leukemia Registry.
abstract: Patients with secondary acute myeloid leukemia (AML) often escape inclusion in clinical trials and thus, population-based studies are crucial for its accurate characterization. In this first large population-based study on secondary AML, we studied AML with an antecedent hematological disease (AHD-AML) or therapy-related AML (t-AML) in the population-based Swedish Acute Leukemia Registry. The study included 3,363 adult patients of which 2,474 (73.6%) had de novo AML, 630 (18.7%) AHD-AML, and 259 (7.7%) t-AML. Secondary AML differed significantly compared to de novo AML with respect to age, gender, and cytogenetic risk. Complete remission (CR) rates were significantly lower but early death rates similar in secondary AML. In a multivariable analysis, AHD-AML (HR 1.51; 95% CI 1.26-1.79) and t-AML (1.72; 1.38-2.15) were independent risk factors for poor survival. The negative impact of AHD-AML and t-AML on survival was highly age dependent with a considerable impact in younger patients, but without independent prognostic value in the elderly. Although patients with secondary leukemia did poorly with intensive treatment, early death rates and survival were significantly worse with palliative treatment. We conclude that secondary AML in a population-based setting has a striking impact on survival in younger AML patients, whereas it lacks prognostic value among the elderly patients.
authors.affiliation: Department of Medicine and Regional Tumor Registry, Sahlgrenska University Hospital, Göteborg, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Hulegårdh
authors.forename: Christer
authors.initials: C
authors.lastname: Nilsson
authors.forename: Vladimir
authors.initials: V
authors.lastname: Lazarevic
authors.forename: Hege
authors.initials: H
authors.lastname: Garelius
authors.forename: Petar
authors.initials: P
authors.lastname: Antunovic
authors.forename: Åsa
authors.initials: Å
authors.lastname: Rangert Derolf
authors.forename: Lars
authors.initials: L
authors.lastname: Möllgård
authors.forename: Bertil
authors.initials: B
authors.lastname: Uggla
authors.forename: Lovisa
authors.initials: L
authors.lastname: Wennström
authors.forename: Anders
authors.initials: A
authors.lastname: Wahlin
authors.forename: Martin
authors.initials: M
authors.lastname: Höglund
authors.forename: Gunnar
authors.initials: G
authors.lastname: Juliusson
authors.forename: Dick
authors.initials: D
authors.lastname: Stockelberg
authors.forename: Sören
authors.initials: S
authors.lastname: Lehmann
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D010166:Palliative Care; D011379:Prognosis; D012042:Registries; D012074:Remission Induction; D012307:Risk Factors; D016019:Survival Analysis; D013548:Sweden