Clinical outcomes of therapy-related acute myeloid leukemia: an over 20-year single-center retrospective analysis

INTRODUCTION Therapy -related acute myeloid leukemia (t -AML), a life -threatening complication of cytotoxic therapy, represents an emerging challenge of modern oncology. OBJECTIVES We aimed to evaluate clinical outcomes of patients with t -AML, taking into consideration genetic changes and treatment intensity. PATIENTS AND METHODS We conducted a retrospective analysis of all consecutive AML patients from a single hematology center (hospitalized between 2000 and 2021). The diagnosis of t -AML was established according to the 2016 World Health Organization criteria. Overall survival (OS) and progression -free survival (PFS) were used to evaluate treatment outcomes. Retrospective identification of 17p13 deletion and TP53 mutation was conducted. RESULTS Among 743 patients with AML, 60 (8.1%) were diagnosed with t -AML (63.4% had previous solid tumors). A complex karyotype (CK) and 17p13 deletion were detected in 26.8% and 26.7% of the t -AML cases, respectively, while FLT3-ITD and TP53 mutations occurred in 15.4% and 12.5% of the patients with t -AML, respectively. Median OS and PFS were 13 and 8 months, respectively. The survival outcomes were superior in the patients who underwent an allogenic hematopoietic cell transplantation (alloHCT) than in those treated with intensive chemotherapy alone (median OS, 47 vs 7 months, respectively; P = 0.01). Patients with therapy -related acute promyelocytic leukemia did not reach the median OS, and worse survival was noted in CK than non -CK t -AML (median OS, 6 vs 24 months; P = 0.02). In intensively treated t -AML, the survival was better for the patients younger than 64 years (P = 0.03). In the multivariable Cox proportional hazards regression model, alloHCT was associated with longer OS (hazard ratio, 0.19; 95% CI, 0.04-0.91; P = 0.04). Moreover, we noted a high frequency of treatmentCONCLUSIONS Our study revealed that prognosis of t -AML varies. Hence, the treatment strategy should include performing alloHCT as soon as possible in the patients with an adverse genetic profile.