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Hyperleukocytosis is associated with distinct genetic alterations and is an independent poor‐risk factor in de novo acute myeloid leukemia patients
Author(s) -
Tien FengMing,
Hou HsinAn,
Tsai ChengHong,
Tang JihLuh,
Chen ChienYuan,
Kuo YuanYeh,
Li ChiCheng,
Lin ChienTing,
Yao Ming,
Huang ShangYi,
Ko BorSheng,
Hsu SzuChun,
Wu ShangJu,
Tsay Woei,
Tseng MeiHsuan,
Liu MingChih,
Liu ChiaWen,
Lin LiangIn,
Chou WenChien,
Tien HweiFang
Publication year - 2018
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.13073
Subject(s) - cebpa , npm1 , medicine , oncology , myeloid leukemia , cytogenetics , hematopoietic stem cell transplantation , myeloid , leukemia , transplantation , karyotype , immunology , mutation , biology , genetics , gene , chromosome
Objectives Acute myeloid leukemia ( AML ) with hyperleukocytosis ( HL ) is intuitively thought as a unique group with dismal prognosis. However, comprehensive studies regarding the genetic landscape and clinical outcome in this group of patients are limited. Methods A total of 693 newly diagnosed de novo non‐M3 AML patients were consecutively enrolled. We compared relevant mutations in 20 genes between AML patients with or without HL and exposed their prognostic implications. Results Hyperleukocytosis, defined as initial white blood cell counts above 50 000/μL, occurred in 28.9% of AML patients. HL patients had higher incidences of FLT 3‐ ITD , NPM 1 , DNMT 3A , CEBPA , and TET 2 mutations. Multivariate analysis demonstrated that HL was an independent poor prognostic factor for overall survival and disease‐free survival in total patients, those with intermediate‐risk cytogenetics and normal karyotype irrespective of genetic alterations. Intriguingly, HL predicted poor survival in CEBPA double mutated, NPM 1 + / FLT 3 ‐ ITD ‐ and NPM 1 ‐/ FLT 3 ‐ ITD ‐ patients. Further, HL patients who received allogeneic hematopoietic stem cell transplantation (allo‐ HSCT ) in first complete remission ( CR ) had a significantly longer overall survival and disease‐free survival than those without allo‐ HSCT . Conclusions Hyperleukocytosis is an independent poor prognostic factor irrespective of cytogenetics and mutation status. Allo‐ HSCT in first CR seems to ameliorate the poor prognostic impact of HL .