Outcomes of Patients With Acute Myeloid Leukemia and Bone Marrow Fibrosis

Authors

Samuel Urrutia
Hagop M Kantarjian
Farhad Ravandi-Kashani
Carlos Bueso-Ramos
Rashmi Kanagal-Shamanna
Elias Jabbour
Guillermo Montalban-Bravo
Nicholas J Short
Naval Daver
Gautam Borthakur
Courtney D Dinardo
Tapan M Kadia
Lucia Masarova
Prithviraj Bose
Naveen Pemmaraju
Guillermo Garcia-Manero
Koji Sasaki

Publication Date

11-15-2024

Journal

Journal of Hematology & Oncology

Abstract

The outcomes of patients with acute myeloid leukemia (AML) and bone marrow fibrosis (MF) are not well defined. The study objectives were to evaluate the degrees of MF in AML, and corresponding response rates and outcomes. We performed a retrospective review of 2302 patients with AML. We annotated the clinical and molecular characteristics, response to therapy, and survival outcomes of patients with bone marrow fibrosis. Overall, 492 patients (21.4%) had a reported microscopic evaluation of MF: 344 (69.9%) had MF grade 0-1 and 148 (30.1%) had MF grade 2-3. Patients with MF 2-3 had a higher proportion of complex cytogenetics (39.2% vs. 24.7%, p = 0.002) JAK2 mutations (25.7% vs. 18%, p = 0.07) and lower proportion of IDH2 (16.9% vs. 25.9%, p = 0.03) and CEBPA (15.5% vs. 27.6%, p = 0.006) mutations. 64% were treated with low-intensity chemotherapy (LIT) and 36.1% with intensive chemotherapy (IT). The complete remission (CR)/CR with incomplete count recovery (CRi) rates were 63.5% with IC versus 37.9% with LIT (p = 0.007). In patients aged 60 or older 4-week mortality was 12.5% with IC vs. 9.3% with LIT (p = 0.8). The median overall survival (OS) was 14.2 with MF 0-1 versus 7.5 months with MF 2-3 (p < 0.005). In patients aged 60 or older with MF 2-3 median OS was 6.5 months with IT versus 7.0 months with LIT (p = 0.19). In a multivariate analysis, grade 2-3 MF (HR 2.0, 95%CI 1.59-2.51) was the strongest prognostic factor for survival. In summary, grade 2-3 MF in AML is associated with worse outcomes.

Keywords

Humans, Leukemia, Myeloid, Acute, Male, Female, Middle Aged, Retrospective Studies, Aged, Adult, Primary Myelofibrosis, Aged, 80 and over, Young Adult, Mutation, Treatment Outcome, Prognosis, Adolescent, Bone Marrow, Bone marrow fibrosis, Acute myeloid leukemia, Prognostication

DOI

10.1186/s13045-024-01630-w

PMID

39548557

PMCID

PMC11568598

PubMedCentral® Posted Date

11-15-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes