POOR RESPONSE TO INTENSIVE CHEMOTHERAPY IN DE-NOVO ACUTE MYELOID-LEUKEMIA WITH TRILINEAGE MYELODYSPLASIA

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 (P=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 thanthe 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.