Feng-Ming Tien1,2,3, Hsin-An Hou1, Cheng-Hong Tsai1,3, Jih-Luh Tang1,3, Chien-Yuan Chen1, Yuan-Yeh Kuo4, Chi-Cheng Li1,3, Chien-Ting Lin1,3, Ming Yao1, Shang-Yi Huang1, Bor-Sheng Ko1, Szu-Chun Hsu5, Shang-Ju Wu1, Woei Tsay1, Mei-Hsuan Tseng1, Ming-Chih Liu6, Chia-Wen Liu6, Liang-In Lin7, Wen-Chien Chou1,5, Hwei-Fang Tien1. 1. Department of Internal Medicine, Division of Hematology, National Taiwan University Hospital, Taipei, Taiwan. 2. Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan. 3. Tai-Cheng Stem Cell Therapy Center, National Taiwan University, Taipei, Taiwan. 4. Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan. 5. Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan. 6. Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan. 7. Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan.
Abstract
OBJECTIVES: Acute myeloid leukemia (AML) with hyperleukocytosis (HL) is intuitively thought as a unique group with dismal prognosis. However, comprehensive studies regarding the genetic landscape and clinical outcome in this group of patients are limited. METHODS: A total of 693 newly diagnosed de novo non-M3 AML patients were consecutively enrolled. We compared relevant mutations in 20 genes between AML patients with or without HL and exposed their prognostic implications. RESULTS: Hyperleukocytosis, defined as initial white blood cell counts above 50 000/μL, occurred in 28.9% of AML patients. HL patients had higher incidences of FLT3-ITD, NPM1, DNMT3A, CEBPA, and TET2 mutations. Multivariate analysis demonstrated that HL was an independent poor prognostic factor for overall survival and disease-free survival in total patients, those with intermediate-risk cytogenetics and normal karyotype irrespective of genetic alterations. Intriguingly, HL predicted poor survival in CEBPA double mutated, NPM1 + /FLT3-ITD- and NPM1-/FLT3-ITD- patients. Further, HL patients who received allogeneic hematopoietic stem cell transplantation (allo-HSCT) in first complete remission (CR) had a significantly longer overall survival and disease-free survival than those without allo-HSCT. CONCLUSIONS: Hyperleukocytosis is an independent poor prognostic factor irrespective of cytogenetics and mutation status. Allo-HSCT in first CR seems to ameliorate the poor prognostic impact of HL.
OBJECTIVES:Acute myeloid leukemia (AML) with hyperleukocytosis (HL) is intuitively thought as a unique group with dismal prognosis. However, comprehensive studies regarding the genetic landscape and clinical outcome in this group of patients are limited. METHODS: A total of 693 newly diagnosed de novo non-M3 AMLpatients were consecutively enrolled. We compared relevant mutations in 20 genes between AMLpatients with or without HL and exposed their prognostic implications. RESULTS: Hyperleukocytosis, defined as initial white blood cell counts above 50 000/μL, occurred in 28.9% of AMLpatients. HL patients had higher incidences of FLT3-ITD, NPM1, DNMT3A, CEBPA, and TET2 mutations. Multivariate analysis demonstrated that HL was an independent poor prognostic factor for overall survival and disease-free survival in total patients, those with intermediate-risk cytogenetics and normal karyotype irrespective of genetic alterations. Intriguingly, HL predicted poor survival in CEBPA double mutated, NPM1 + /FLT3-ITD- and NPM1-/FLT3-ITD- patients. Further, HL patients who received allogeneic hematopoietic stem cell transplantation (allo-HSCT) in first complete remission (CR) had a significantly longer overall survival and disease-free survival than those without allo-HSCT. CONCLUSIONS: Hyperleukocytosis is an independent poor prognostic factor irrespective of cytogenetics and mutation status. Allo-HSCT in first CR seems to ameliorate the poor prognostic impact of HL.
Authors: Laetitia Largeaud; Sarah Bertoli; Emilie Bérard; Eric Delabesse; Christian Récher; Suzanne Tavitian; Muriel Picard; Stéphanie Dufrechou; Naïs Prade; François Vergez; Jean Baptiste Rieu; Isabelle Luquet; Audrey Sarry; Françoise Huguet; Jean Ruiz; Véronique De Mas Journal: Blood Cancer J Date: 2022-01-05 Impact factor: 11.037
Authors: Jennifer B Dunlap; Jessica Leonard; Mara Rosenberg; Rachel Cook; Richard Press; Guang Fan; Philipp W Raess; Brian J Druker; Elie Traer Journal: Am J Hematol Date: 2019-06-21 Impact factor: 13.265