Outcomes for patients with chronic lymphocytic leukemia and acute leukemia or myelodysplastic syndrome.
Acute leukemia (AL) and myelodysplastic syndrome (MDS) are uncommon in chronic lymphocytic leukemia (CLL). We retrospectively identified 95 patients with CLL, also diagnosed with AL (n=38) or MDS (n=57), either concurrently (n=5) or subsequent (n=90) to CLL diagnosis and report their outcomes. Median number of CLL treatments prior to AL and MDS was 2 (0-9) and 1 (0-8), respectively; the most common regimen was purine analog combined with alkylating agent±CD20 monoclonal antibody. Twelve cases had no prior CLL treatment. Among 38 cases with AL, 33 had acute myelogenous leukemia (AML), 3 had acute lymphoid leukemia (ALL; 1 Philadelphia chromosome positive), 1 had biphenotypic and 1 had extramedullary (bladder) AML. Unfavorable AML karyotype was noted in 26, and intermediate risk in 7 patients. There was no association between survival from AL and number of prior CLL regimens or karyotype. Expression of CD7 on blasts was associated with shorter survival. Among MDS cases, all International Prognostic Scoring System (IPSS) were represented; karyotype was unfavorable in 36, intermediate in 6 and favorable in 12 patients; 10 experienced transformation to AML. Shorter survival from MDS correlated with higher risk IPSS, poor-risk karyotype and increased number of prior CLL treatments. Overall, outcomes for patients with CLL subsequently diagnosed with AL or MDS were very poor; AL/MDS occurred without prior CLL treatment. Effective therapies for these patients are desperately needed.
S.S.D. TMO-AORN Santobono-Pausilipon, Napoli, Italy.
F P
FP
Tambaro
Department of Leukemia, UT MD Anderson Cancer Center, Houston, TX, USA.
G
G
Garcia-Manero
Department of Leukemia, UT MD Anderson Cancer Center, Houston, TX, USA.
S M
SM
O'Brien
Division of Leukemia, Hackensack University Medical Center, Hackensack, NJ, USA.
S H
SH
Faderl
Department of Leukemia, UT MD Anderson Cancer Center, Houston, TX, USA.
A
A
Ferrajoli
Department of Leukemia, UT MD Anderson Cancer Center, Houston, TX, USA.
J A
JA
Burger
Department of Leukemia, UT MD Anderson Cancer Center, Houston, TX, USA.
S
S
Pierce
Department of Biostatistics, UT MD Anderson Cancer Center, Houston, TX, USA.
X
X
Wang
Department of Biostatistics, UT MD Anderson Cancer Center, Houston, TX, USA.
K-A
KA
Do
Department of Leukemia, UT MD Anderson Cancer Center, Houston, TX, USA.
H M
HM
Kantarjian
Department of Leukemia, UT MD Anderson Cancer Center, Houston, TX, USA.
M J
MJ
Keating
Department of Leukemia, UT MD Anderson Cancer Center, Houston, TX, USA.
W G
WG
Wierda
D000368:Aged; D005260:Female; D006801:Humans; D059785:Karyotype; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000401:mortality* / Q000628:therapy; D015470:Leukemia, Myeloid, Acute / Q000401:mortality*; D008297:Male; D009190:Myelodysplastic Syndromes / Q000401:mortality*; D012189:Retrospective Studies