Prognostic implications of CD14 positivity in acute myeloid leukemia arising from myelodysplastic syndrome
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ORIGINAL ARTICLE
Prognostic implications of CD14 positivity in acute myeloid leukemia arising from myelodysplastic syndrome Yunsuk Choi • Je-Hwan Lee • Sung-Doo Kim • Dae-Young Kim Jung-Hee Lee • Miee Seol • Young-Ah Kang • Mijin Jeon • Ah Rang Jung • Kyoo-Hyung Lee
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Received: 10 September 2012 / Revised: 7 January 2013 / Accepted: 15 January 2013 / Published online: 31 January 2013 Ó The Japanese Society of Hematology 2013
Abstract Secondary acute myeloid leukemia (s-AML) arising from myelodysplastic syndrome (MDS) shows different clinical features from de novo AML. We assessed the prognostic significance of immunophenotypic markers in patients with s-AML arising from MDS. Sixty-five adults diagnosed with AML arising from MDS between 1996 and 2010 were retrospectively analyzed. Immunophenotyping was performed for markers including CD3, CD7, CD10, CD13, CD14, CD19, CD33, CD34, CD41, CD45, CD56, CD65, CD117, HLA-DR, and TdT. Of these immunophenotypic markers, only CD14 positivity was significantly associated with lower complete remission rate (P = 0.034) and significantly shorter overall survival (OS, P \ 0.001) and event-free survival (EFS, P \ 0.001) on univariate analysis. On multivariate analysis, these differences remained significant in terms of OS [hazard ratio (HR) 4.49; P \ 0.001] and EFS (HR 4.06; P \ 0.001). Other significant prognostic variables included age C60 years [shorter OS (P = 0.003) and EFS (P = 0.020)], higher WBC count ([60,000/lL) [shorter OS (P \ 0.001) and EFS (P = 0.001)], and poor cytogenetic risk group [shorter OS (P = 0.005)]. CD14 expression on leukemic blasts is an independent prognostic factor for survival outcomes in patients with AML arising from MDS. Keywords Secondary leukemia Myelodysplasia Immunophenotypic studies
Y. Choi J.-H. Lee (&) S.-D. Kim D.-Y. Kim J.-H. Lee M. Seol Y.-A. Kang M. Jeon A. R. Jung K.-H. Lee Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro-43-gil, Songpa-gu, Seoul 138-736, Korea e-mail: [email protected]
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Introduction Approximately 30–40 % of patients with myelodysplastic syndrome (MDS) develop acute myeloid leukemia (AML). Secondary AML (s-AML) arising from MDS shows different clinical features and outcomes from de novo AML [1]. In 2008, a revision of the World Health Organization (WHO) classification included an ‘‘AML with myelodysplasia-related changes (AML-MRC)’’ group. Patients with s-AML transformed from MDS are assigned to this group [2]. In a comparison of patients with AML-MRC and those with AML, not otherwise specified, overall survival (OS), progression free survival (PFS), and complete remission (CR) rate were significantly worse in the AML-MRC group [3]. The clinical outcomes of patients with a history of MDS have been reported to be similar to those of patients with AML-MRC [3, 4]. However, Haferlach et al. [5] and Wandt et al. [6] could not demonstrate the prognostic relevance of the presence or absence of myelodysplasia in de novo AML. Although sever
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