A RECENT study has shed light on the particularly poor prognosis faced by patients who develop acute myeloid leukaemia (AML) after receiving treatment for myelodysplastic syndrome (MDS) or related conditions. Conducted between January 2012 and August 2023, the study focused on 673 adult patients with newly diagnosed AML, who had a history of MDS, chronic myelomonocytic leukaemia (CMML), or MDS/myeloproliferative neoplasm (MPN) overlap syndrome. These patients had previously undergone various treatments, including hypomethylating agents, chemotherapy, and/or allogeneic stem cell transplantation (HSCT).
The patients, with a median age of 70 years, had a mix of genetic profiles, with 58% exhibiting adverse-risk (AR) cytogenetics and 34% having TP53 mutations. A significant portion (67%) received low-intensity therapy (LIT), while 27% were treated with venetoclax. Among the 497 evaluable patients, the overall response rate was 37%, with venetoclax improving the odds of response in LIT-treated patients.
However, the study found grim survival outcomes. At a median follow-up of 43 months, the median relapse-free survival (RFS) was just 4.6 months, and the median overall survival (OS) was 4.8 months. Multivariate analysis revealed that prior therapy for non-myeloid disorders, multiple lines of therapy for antecedent myeloid disorders, and adverse-risk classification according to the European LeukemiaNet (ELN) 2017 criteria all increased the risk of death. Conversely, HSCT was associated with improved survival.
These findings underscore the challenges of treating patients with therapy-related AML (TS-AML), calling for the inclusion of TS-AML as an independent adverse-risk category in prognostic assessments and clinical trial evaluations.
Helena Bradbury, EMJ
Reference
Senapati J et al. Outcomes of Patients With Treated Secondary Acute Myeloid Leukemia: A High-Risk Subtype That Warrants an Independent Prognostic Designation. Am J Hematol. 2025;100(2):249-259.
