Clinical Characteristics And Prognosis Of Secondary Acute Myeloid Leukemia

BankgroundAcute myeloid leukemia(AML)is the most common type of Acute leukemia in adults.Secondary acute myeloid leukemia(S-AML)refers to AML developing either after a prior hematologic disorder,such as myelodysplastic syndrome(MDS)or myeloproliferative neoplasms(MPN),or leukemia that is formed after solid tumors have been treated with cytotoxic drugs,radiation and chemotherapy.Compared with primary AML,S-AML has a lower incidence,poorer prognosis,and shorter overall survival(OS).At present,the clinical treatment for S-AML patients is still based on the actual situation of the patients to constantly adjust the treatment strategy and therapeutic regimen,so as to carry out individualized treatment,in order to achieve the purpose ofimproving the remission rate and prognosis.Accurate diagnosis and classification of leukemia are the prerequisites for the correct selection of treatment.Currently,MICM classification is commonly and internationally used,including morphology(M),immunology(I),cytogenetics(C)and molecular biology(M).This classification method is very important for the evaluation,treatment and prognosis of leukemia.In recent years,with the improvement of medical technology and the rapid development of cytogenetics and molecular biology,chromosomal abnormalities have been increasingly recognized to play an important role in the diagnosis and prognosis of hematological tumors such as AML.Therefore,understanding the role of chromosomal abnormalities in patients with S-AML may be useful for further risk stratification of the disease.Based on domestic and foreign literature,there are few clinical studies on S-AML at present.Therefore,it is very important to understand the clinical characteristics,morphology,immunophenotype,and chromosomal abnormalities of S-AML patients for the early diagnosis,early treatment,and prognosis evaluation of S-AML.ObjectiveIn this study,the basic clinical characteristics of S-AML patients were collected,and the morphology,immunophenotype and chromosome of patients were analyzed in detail to explore the factors that may affect the survival and prognosis of S-AML patients.MethodsA total of 41 patients with S-AML admitted to our hospital from January 2009 to March 2020 were collected.The clinical manifestations,bone marrow cytology,flow immunotyping of bone marrow or peripheral blood,bone marrow karyotypes,treatment regimen,and relevant laboratory indicators of S-AML patients at the initial diagnosis of AML were collected to analyze the clinical characteristics and the relationship between clinical features and prognosis.Results(1)The median age of the 41 S-AML patients was 62 years old(range,20-78 years old),22 males and 19 females,39 patients(95.1%)were secondary to hematological system tumors,and 63.4% of S-AML patients were secondary to MDS.(2)Among the chromosomal results of 26 S-AML patients collected,10 cases were normal karyotypes and 16 cases were abnormal karyotypes.(3)The immunophenotypic analysis of S-AML patients showed the expression of concomitant with lymphoid lines,mainly with CD7,CD56 and CD4 expressions.The expression of concomitant lymphoid antigens had no significant correlation with chromosomal abnormalities(P>0.05).(4)Mann-Whitney U test showed that the serum lactate dehydrogenase(LDH)level of S-AML patients with abnormal karyotype was higher than that of normal karyotypes(P<0.05).(5)Kaplan-Meier survival curve analysis showed that the prognosis of S-AML patients with abnormal karyotypes was worse than that of normal karyotypes(P<0.05).(6)Kaplan-Meier survival curve results showed that compared with normal karyotypes,the overall survival(OS)of hyperdiploid was lower,and the overall survival rate of subdiploid was much lower(P<0.05).ConclusionMost of the chromosomes in S-AML patients have abnormal karyotypes,and the level of LDH in patients with abnormal karyotypes is higher than that of normal karyotypes.In addition,Overall survival(OS)of S-AML patients with abnormal karyotype was shorter than that of normal karyotype,and OS of subdiploid patients was shorter than that of hyperdiploid patients.LDH and karyotype abnormalities in S-AML patients are closely related to disease severity and survival prognosis,which may be valuable indicators for further S-AML risk stratification in the future,so as to obtain personalized treatment based on risk stratification development.