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Extramedullary disease not prognostic for survival in AML
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Extramedullary disease is common in patients with acute myeloid leukemia but is not an independent prognostic factor, study data showed.
“The prognostic impact of extramedullary disease is unfavorable in some reports but not in others,” Chezi Ganzel, MD, of the Shaare Zedek Medical Center in Jerusalem and Memorial Sloan Kettering Cancer Center in New York, and colleagues wrote. “The objectives were to describe the demographic, clinical and biologic characteristics of patients with newly diagnosed acute myeloid leukemia (AML) with extramedullary disease and to evaluate how the presence, extent and characteristics of extramedullary disease may affect response to treatment and outcome.”
The researchers analyzed records of 3,240 patients with AML aged 15 years and older who were enrolled in 11 ECOG-ACRIN Cancer Research Group clinical trials between 1980 and 2008.
Nearly one-quarter (23.7%) of the cohort had extramedullary disease; of this group, 65.3% had disease at one site, 20.9% had disease at two sites, 9.5% had disease at three sites and 3.4% had disease at four sites. Affected sites included lymph nodes (11.5%), spleen (7.3%), liver (5.3%), skin (4.5%), gingiva (4.4%) and central nervous system (1.1%).
Median OS was 1.03 years.
A univariable analysis indicated the presence of any extramedullary disease was associated with shorter OS (P = .005), as was the presence of disease at the skin (P = .002), spleen (P < .001) and liver (P < .001). However, when researchers performed a multivariable analysis that accounted for known prognostic factors — including white blood cell count and cytogenetic risk — neither the presence of any extramedullary disease nor the number of sites involved were independently prognostic.
“This large study demonstrates that extramedullary disease is more common than previously reported and frequently occurs in multiple sites, although CNS involvement is rare,” Ganzel and colleagues wrote. “Perhaps surprisingly, extramedullary disease at presentation does not have independent prognostic significance. Importantly, the presence of extramedullary disease should not affect the choice of postremission therapy.” – by Andy Polhamus
Disclosure: Ganzel reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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