Significance of trilineage myelodysplasia in de novo acute myeloid leukemia

Kim, Ji Myong; Seo, Eul Zu; Park, Chan Jeoung; Chi, Hyun Sook

Abstract

BACKGROUND: The findings of dysplastic features in haemopoietic cells in de novo acute myeloid leukemia(AML) is defined as AML with trilineage myelodysplasia(AML/TMDS). These cases have been reported accounting for 10-5% of de novo AML. The rate of complete remission(CR) in AML/TMDS to conventional chemotherapy is poor and relapse occur much earlier than in patients without dysplastic features. TMDS features are also observed during remission and termed this de novo AML with myelodysplastic remission marrow(AML/MRM). Recent report described that TMDS during remission was more closely related to prognosis than dysplastic features at diagnosis. We investigated the incidence of AML/TMDS and AML/MRM and evaluated the impending role of dysplasia in prognosis. METHOD: Ninety-ive patients with de novo AML from March 1994 to December 1998 were enrolled according to the FAB classifiction. To determine AML/TMDS and AML/MRM, we used Brito-abapulle's criteria and Kazuhiro's criteria. Prognosis was aalysed by the means of disease free survival(DFS) and overall survival(OS).
RESULTS
Nine(9.5%) patients had AML/TMDS and it was 7.7%, 17.2%, 50% of patients with M2, M4 and M6. CR rate was 44.4% for TMDS patients compared to 76.7% for patients without TMDS(p<0.05). AML/TMDS also showed significantly shorter DFS and OS. The incidence of AML/MRM was higher in the group of AML/TMDS(44.4%) compared to AML without TMDS(8.1%) but was not related to prognosis.
CONCLUSION
We concluded that the presence of TMDS in de novo AML exerts a negative effect on the ability to achieve CR and in the prognosis. But the MRM has no significance to predict poor prognosis and early relapse.