Abstract
Outcomes of patients with bone marrow fibrosis in de novo and secondary acute myeloid leukemia.
Author
person
Samuel Urrutia
The University of Texas MD Anderson Cancer Center, Houston, TX
info_outline
Samuel Urrutia, Hagop M. Kantarjian, Farhad Ravandi-Kashani, Elias Jabbour, Rashmi Kanagal-Shamanna, Sanam Loghavi, Keyur P. Patel, Guillermo Montalban-Bravo, Nicholas James Short, Naval Guastad Daver, Gautam Borthakur, Courtney Denton Dinardo, Tapan M. Kadia, Lucia Masarova, Prithviraj Bose, Naveen Pemmaraju, Guillermo Garcia-Manero, Koji Sasaki
Full text
Authors
person
Samuel Urrutia
The University of Texas MD Anderson Cancer Center, Houston, TX
info_outline
Samuel Urrutia, Hagop M. Kantarjian, Farhad Ravandi-Kashani, Elias Jabbour, Rashmi Kanagal-Shamanna, Sanam Loghavi, Keyur P. Patel, Guillermo Montalban-Bravo, Nicholas James Short, Naval Guastad Daver, Gautam Borthakur, Courtney Denton Dinardo, Tapan M. Kadia, Lucia Masarova, Prithviraj Bose, Naveen Pemmaraju, Guillermo Garcia-Manero, Koji Sasaki
Organizations
The University of Texas MD Anderson Cancer Center, Houston, TX, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
Abstract Disclosures
Research Funding
No funding sources reported
Background:
The outcomes of patients with
de novo
acute myeloid leukemia (AML) with bone marrow fibrosis (MF) have not been systematically studied. Our objective was to define the prognosis of patients with AML and multiple degrees of bone marrow fibrosis, efficacy of therapy, and survival outcomes.
Methods:
We retrospectively evaluated 2302 patients diagnosed with AML at a single center from 2007 to 2023 and annotated clinicopathologic characteristics and outcomes.
Results:
We identified 492 (21%) with AML and MF. We found 344 (69.9%) had MF 0-1 and 148 (30.1%) had MF 2-3. Median age was 67 (IQR: 57-73). Fifty-five (11.1%) had a history of myeloproliferative neoplasm (MPN). Patients with MF 2-3 were associated with complex cytogenetics (39.2%),
JAK2
mutations (25.7%), and lower incidence of
IDH2
(16.9%) or
CEBPA
(15.5%) mutations (Table). For patients with MF 0-1, median overall survival (mOS) was 14.2 months compared to 7.5 months for those with MF 2-3 (p<0.005). Survival in patients with MPN history was 9.4 months compared to 12.4 months in patients with
de novo
AML. In a multivariate analysis, MF 2-3 (HR 2.00 95%CI 1.59-2.51), non-diploid cytogenetics (HR 1.29, 95%CI 1.33-1.69), and number of co-morbidities (HR 1.26 95%CI 1.10-1.43) were prognostic for shorter mOS. Sixty-four percent were treated with low-intensity chemotherapy (LIC), 36.1% with intensive chemotherapy (IC). Complete remission (CR)/CR with incomplete count recovery (CRi) rates were 63.5% for IC vs 37.9% for LIC (p=0.007). Four-week mortality after induction was 5.8% with IC, 8.4% with LIC (p = 0.809). In patients aged 60 and older, with MF 2-3, intensive therapy did not result in improved survival (6.5 months vs 7.0 months, p = 0.19).
Conclusions:
Patients with AML and MF 2-3 have worse outcomes irrespective of MPN history. For patients aged 60 and above, intensive chemotherapy does not result in improved survival.
Patient characteristics by degree of marrow fibrosis mild (0-1), advanced (2-3).
No. (%) / median [IQR]
Overall (n=492)
MF 0-1
(n=344)
MF 2-3
(n=148)
p
Female, n (%)
224 (45.5)
162 (47.1)
62 (41.9)
0.335
Age
67.0 [57.0, 73.0]
67.0 [57.0,74.0]
66.0 [56.8,72.0]
0.508
ANC x10
9
/L
0.7 [0.2, 2.0]
0.6 [0.2,1.7]
1.1 [0.4,3.0]
<0.001
Hemoglobin g/dL
9.2 [8.6, 9.7]
9.3 [8.6,9.8]
9.1 [8.5,9.6]
0.07
Platelet count x10
3
/L
34.0 [19.0, 71.5]
37.0 [20.0,69.0]
31.0 [17.0,75.5]
0.289
Bone marrow blast %
41.0 [24.0, 65.0]
47.0 [26.0,69.0]
30.0 [22.0,52.5]
<0.001
Diploid CG
143 (29.1)
109 (31.7)
34 (23.0)
0.065
Complex CG
143 (29.1)
85 (24.7)
58 (39.2)
0.002
History of MPN
145 (29.5)
90 (26.2)
55 (37.2)
0.019
TET2
194 (39.4)
141 (41.0)
53 (35.8)
0.328
JAK2
100 (20.3)
62 (18.0)
38 (25.7)
0.07
RAS
130 (26.4)
93 (27.0)
37 (25.0)
0.72
CEBPA
118 (24.0)
95 (27.6)
23 (15.5)
0.006
IDH2
114 (23.2)
89 (25.9)
25 (16.9)
0.04
OS (months), median
11.3
14.2
7.5
<0.001
OS: overall survival.
3 organizations
Organization
The University of Texas MD Anderson Cancer Center, Stem Cell Transplantation Rsch, Houston, TXOrganization
Department of Leukemia