Acute Myeloid Leukemia progression in Myelodysplastic Syndromes, results from the Argentine registry

ENRICO, ALICIA; KORNBLIHTT, LAURA; MILONE, JORGE; ARBELBIDE, JORGE; FANTL, DOROTEA; ALFONSO, GRACIELA; IASTREBNER, MARCELO; FLORES, GABRIELA; CORREA, WALTER A; NEGRI ARANGUREN, PEDRO; CELEBRIN, LUCIA; AGRA, MARCELA; WATMAN, NORA; BASQUIERA, ANA L; BESTACH, YESICA; BENGIÓ, RAQUEL; LARRIPA, IRENE; BELLI, CAROLINA

Milan

Congreso; 19th Congress of the European Haematology Association; 2014

EHA

Background: At least, one third of patients with Myelodysplastic Syndromes (MDS) develops Acute Myeloid Leukemia (AML) at any time of the follow-up. This subgroup of patients depict clinical and laboratory features, specific MDS subtype, and especially poor prognosis. Aims: To describe and analyze clinical features of adult MDS patients that had progressed to AML Methods: This is a multicenter retrospective study of 197 (23%) adult MDS patients that progressed to secondary AML (s-AML), from a database of 840 patients diagnosed from 1981 to 2013. Data belong to the MDS Registry sponsored by the Argentinean Society of Hematology and to a previous multicenter study. Informed Consent was required. Patients were classified following FAB and WHO criteria and 13 patients presented with secondary MDS. The median age was 64 (17-89) years with 74% above 60 years, a male/female (123/74) ratio of 1.7. During the follow-up, with a median overall survival of 14.3 months, 173 (88%) died. BM transplanted patients were censored till the moment of the procedure. Using a log-rank test and Kaplan-Meier, we performed a univariate analysis to examine the effects of age at MDS diagnosis (limit of 70 years), gender, haematological parameters and, IPSS, WPSS and IPSS-R scores on time to Leukemia transformation (TTL) and on the overall survival (OS). Results: FAB classification was evaluable in 184 patients distributed into: RA 37 (20%), RARS 7 (4%), RAEB 71 (39%), RAEB-T 39 (21%), CMML 30 (16%). WHO classification was evaluable in 134 patients: RCUD/5q- 10 (7%), RCMD 34 (25%), RAEB-1 33 (25%), and RAEB-2 57 (43%). Age (limit of 70 years), percentage of bone marrow blast (0-5, 5-10, 11-20, 20), hemoglobin level (limit of 10 g/dL), platelets (limit of 100000 /μL) and neutrophil count (limit of 800 /μL), LDH level, cytogenetic group of risk (according to the IPSS-R), and red blood cell transfusion requirements were significant predictive variables for prognosis (Kaplan- Meier and Long-Rank test, p0.05). According to our database, most patients received supportive care with vitaminotherapy; erytroid and neutrophil stimulating factors, and 158 required red blood cells transfusion support. Chemotherapy was administered once the leukemic phase of the disease was diagnosed (68 patients) or for stem cell transplant (14 patients), hypomethylating agents were administered in 66 patients, and 2 lenalidomide. Summary/Conclusion: Our multicenter Argentinean cohort showed a rate of 23.4% of patients who progress to s-AML, similar to previous reports. Clinical parameters, age, classifications and the applied scoring systems were useful tools to evaluate prognosis in our series. As expected, we observed a higher gender ratio, a lower median age and an increased incidence of higher risk groups, but the shorter time to AML in lower risk group will be matter of future studies.