Poor response to intensive chemotherapy in de novo acute myeloid leukaemia with trilineage myelodysplasia

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Abstract
Summary. The findings of morphologically dysplastic features in haemopoietic cells in de novo acute myeloid leukaemia (AML) has been named AML with trilineage myelodysplasia (AML/TMDS). We analysed the clinical data, karyotypes, and treatment outcomes of 230 de novo AML patients treated with the Japan Adult Leukaemia Study Group AML‐87 protocol. 40 (17%) patients had AML/TMDS. Platelet count was significantly higher (F=0·006) and bone marrow blasts were fewer (P=0·01) in the AML/TMDS group than in the AML without TMDS. Abnormal karyotype was shown in 12/30 patients (40%) analysed. The complete remission (CR) rate for AML/TMDS was significantly lower than AML without TMDS (63%v 81%) (P=0·01). The overall survival curves showed that the 40 patients with TMDS had a significantly worse survival than the 190 without TMDS (P=0·0005). AML/TMDS also showed significantly worse disease‐free survival (DFS) (P=0·0001). Multivariate analysis revealed that the absence of TMDS in AML was the most significant factor in obtaining CR (P=0·01) and a significant factor in predicting longer DFS (P=0·04). Our data suggest that AML/TMDS responds poorly to intensive chemotherapy. Further study is required to determine the best treatment strategy for AML/TMDS and the biological differences between AML/TMDS and other types of AML.

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