Clinical Characteristics and Optimal Therapy of Acute Myeloid Leukemia with Myelodysplasia-related-changes: A Retrospective Analysis in a Cohort of Chinese Patients.

2021 
Objective This study aimed to investigate the clinical characteristics of acute myeloid leukemia with myelodysplasia-related-changes (AML-MRC) according to the 2016 WHO classification and the preferred therapy of patients with AML-MRC and aged 60-75 years. Materials and Methods We retrospectively analyzed the differences of clinical data between 190 patients with AML-MRC and 667 patients with AML not otherwise specified (AML-NOS). And we compared different therapeutic regimens among patients with AML-MRC and aged 60-75 years. Results Compared with AML-NOS, patients with AML-MRC had significantly different clinical characteristics as well as worse overall survival (OS) (9.2 vs 13.6 months; p<0.001) and complete remission (CR) rate (65.3% vs 76.2%; p=0.005). Multivariate analysis performed in the whole group (patients with AML-MRC and AML-NOS) showed that AML-MRC was the independent prognostic factor (p=0.002). Additional multivariate analysis performed in 190 patients with AML-MRC indicated that age (p<0.001) and LDH (p=0.031) were independent prognostic factors. Compared with IA/DA regimen [idarubin and cytarabine (IA) or daunorubicin and cytarabine (DA)], DAC+CAG regimen [decitabine and half-dose CAG regimen (cytarabine, aclarubicin and granulocyte colony-stimulating factor)] was associated with better OS (4.5 vs 6.2 months; p=0.021) in patients aged 60-75 years and categorized into unfavorable-risk group. Conclusion AML-MRC exhibited worse clinical outcome compared with AML-NOS. Compared with IA/DA regimen, DAC+CAG regimen was the optimal choice for patients with AML-MRC in unfavorable-risk group and aged 60-75 years.
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