title: Prior cytopenia predicts worse clinical outcome in acute myeloid leukemia.
abstract: The prognosis of acute myeloid leukemia (AML) is influenced by both disease-intrinsic and patient-related factors. In particular, AML following myelodysplastic syndrome (MDS) (AML with myelodysplasia-related changes, AML-MRC) has a poor prognosis. We hypothesized that patients with cytopenias prior to AML, but no known prior MDS, may share biologic features with AML-MRC. We evaluated 140 AML patients without prior MDS who had complete blood count (CBC) data available 6-36 months prior to their diagnosis. Cytopenia, defined as clinically unexplained thrombocytopenia or macrocytic anemia, was present in 29/140 (21%) patients. Compared to non-cytopenic patients, AML patients with prior cytopenia were older and more often met morphologic or cytogenetic criteria for AML-MRC. Prior cytopenia was associated with shorter survival in patients with intermediate-risk cytogenetics (median OS 4.2 versus 24.1 months, p<0.0001), but not in patients with adverse-risk cytogenetics (median OS 4.4 versus 6.0 months, p=0.57). Prior thrombocytopenia, but not macrocytic anemia, was significantly associated with shorter overall survival (p=0.01) independent of treatment approach, karyotype risk, and age on multivariable analysis. Our data suggest that AML patients with prior cytopenias have features similar to AML-MRC, and in particular support the use of prior unexplained thrombocytopenia as an independent marker of high-risk disease.
authors.affiliation: Department of Pathology, Massachusetts General Hospital, United States.
authors.forename: Amelia
authors.initials: A
authors.lastname: Huck
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, United States.
authors.forename: Olga
authors.initials: O
authors.lastname: Pozdnyakova
authors.affiliation: Department of Hematology/Oncology, Massachusetts General Hospital, United States.
authors.forename: Andrew
authors.initials: A
authors.lastname: Brunner
authors.affiliation: Department of Pathology, Massachusetts General Hospital, United States.
authors.forename: John M
authors.initials: JM
authors.lastname: Higgins
authors.affiliation: Department of Hematology/Oncology, Massachusetts General Hospital, United States.
authors.forename: Amir T
authors.initials: AT
authors.lastname: Fathi
authors.affiliation: Department of Pathology, Massachusetts General Hospital, United States. Electronic address: rhasserjian@partners.org.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Hasserjian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000748:Anemia, Macrocytic / Q000453:epidemiology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D015470:Leukemia, Myeloid, Acute / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D013921:Thrombocytopenia / Q000453:epidemiology*; D055815:Young Adult
keywords: Acute myeloid leukemia; Cytopenia; Myelodysplastic syndrome