The following is a summary of “Outcomes of Patients With Treated Secondary Acute Myeloid Leukemia: A High-Risk Subtype That Warrants an Independent Prognostic Designation,” published in the December 2024 issue of Hematology by Senapati et al. 

Acute myeloid leukemia (AML) following treatment for myelodysplastic syndrome (MDS) or related conditions leads to poor outcomes.  

Researchers conducted a retrospective study on adults with AML transformed from MDS, chronic myelomonocytic leukemia (CMML), or MDS/myeloproliferative neoplasm (MPN), analyzing outcomes after prior hypomethylating agents, chemotherapy, or allogeneic stem cell transplantation (HSCT). 

They analyzed 673 patients (median age 70 years; range 19–94) diagnosed between January 2012 and August 2023. Of these, 536 (80%) transformed from MDS, and the rest from CMML or MDS-MPN. Data on cytogenetics, TP53 mutations, ELN 2017 classification, and treatments, including low-intensity therapy (LIT) and venetoclax, were collected. Survival outcomes were assessed using multivariate and gradient-boosted regression models. 

The results showed a 37% overall response rate (ORR), with venetoclax improving response odds (OR = 2.5). Median relapse-free survival (RFS) and overall survival (OS) were 4.6 and 4.8 months. Prior therapy for non-myeloid malignancies (HR = 1.30), ≥2 lines of antecedent therapy (HR = 1.23), and ELN adverse-risk (AR) risk (HR = 1.47) increased death hazards, while HSCT was beneficial (HR = 0.50). 

Investigators concluded that treated secondary (TS)-AML was associated with poor outcomes, supporting its inclusion as an independent AR category for better prognostication. 

Source: onlinelibrary.wiley.com/doi/10.1002/ajh.27561