Title |
Azacitidine front-line in 339 patients with myelodysplastic syndromes and acute myeloid leukaemia: comparison of French-American-British and World Health Organization classifications
|
---|---|
Published in |
Journal of Hematology & Oncology, April 2016
|
DOI | 10.1186/s13045-016-0263-4 |
Pubmed ID | |
Authors |
Lisa Pleyer, Sonja Burgstaller, Reinhard Stauder, Michael Girschikofsky, Heinz Sill, Konstantin Schlick, Josef Thaler, Britta Halter, Sigrid Machherndl-Spandl, Armin Zebisch, Angelika Pichler, Michael Pfeilstöcker, Eva-Maria Autzinger, Alois Lang, Klaus Geissler, Daniela Voskova, Dietmar Geissler, Wolfgang R. Sperr, Sabine Hojas, Inga M. Rogulj, Johannes Andel, Richard Greil |
Abstract |
The MDS-IWG and NCCN currently endorse both FAB and WHO classifications of MDS and AML, thus allowing patients with 20-30 % bone marrow blasts (AML20-30, formerly MDS-RAEB-t) to be categorised and treated as either MDS or AML. In addition, an artificial distinction between AML20-30 and AML30+ was made by regulatory agencies by initially restricting approval of azacitidine to AML20-30. Thus, uncertainty prevails regarding the diagnosis, prognosis and optimal treatment timing and strategy for patients with AML20-30. Here, we aim to provide clarification for patients treated with azacitidine front-line. The Austrian Azacitidine Registry is a multicentre database (ClinicalTrials.gov: NCT01595295). For this analysis, we selected 339 patients treated with azacitidine front-line. According to the WHO classification 53, 96 and 190 patients had MDS-RAEB-I, MDS-RAEB-II and AML (AML20-30: n = 79; AML30+: n = 111), respectively. According to the FAB classification, 131, 101 and 111 patients had MDS-RAEB, MDS-RAEB-t and AML, respectively. The median ages of patients with MDS and AML were 72 (range 37-87) and 77 (range 23-93) years, respectively. Overall, 80 % of classifiable patients (≤30 % bone marrow blasts) had intermediate-2 or high-risk IPSS scores. Most other baseline, treatment and response characteristics were similar between patients diagnosed with MDS or AML. WHO-classified patients with AML20-30 had significantly worse OS than patients with MDS-RAEB-II (13.1 vs 18.9 months; p = 0.010), but similar OS to patients with AML30+ (10.9 vs 13.1 months; p = 0.238). AML patients that showed MDS-related features did not have worse outcomes compared with patients who did not (13.2 vs 8.9 months; p = 0.104). FAB-classified patients with MDS-RAEB-t had similar survival to patients with AML30+ (12.8 vs 10.9 months; p = 0.376), but significantly worse OS than patients with MDS-RAEB (10.9 vs 24.4 months; p < 0.001). Our data demonstrate the validity of the WHO classification of MDS and AML, and its superiority over the former FAB classification, for patients treated with azacitidine front-line. Neither bone marrow blast count nor presence of MDS-related features had an adverse prognostic impact on survival. Patients with AML20-30 should therefore be regarded as having 'true AML' and in our opinion treatment should be initiated without delay. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 1 | 100% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 1 | 100% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Peru | 1 | 2% |
Unknown | 42 | 98% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Researcher | 8 | 19% |
Student > Postgraduate | 6 | 14% |
Other | 5 | 12% |
Professor > Associate Professor | 4 | 9% |
Student > Master | 2 | 5% |
Other | 5 | 12% |
Unknown | 13 | 30% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 20 | 47% |
Biochemistry, Genetics and Molecular Biology | 3 | 7% |
Pharmacology, Toxicology and Pharmaceutical Science | 3 | 7% |
Nursing and Health Professions | 2 | 5% |
Computer Science | 1 | 2% |
Other | 0 | 0% |
Unknown | 14 | 33% |