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Therapy

Allogeneic bone marrow transplantation improves the outcome of de novo AML with trilineage dysplasia (AML-TLD)

Leukemia volume 14, pages 1861–1866 (2000)Cite this article

Abstract

De novo acute myeloid leukemia (AML) with dysplastic features in erythroblasts, granulocytes and megakaryocytes, similar to those in myelodysplastic syndrome (MDS) has been described as AML with trilineage dysplasia (AML-TLD) since 1987. Several reports have suggested that AML-TLD is a subtype of de novo AML in adults and has a poor clinical outcome when treated by conventional chemotherapy. It is not certain whether allogeneic bone marrow transplantation (BMT) brings a favorable outcome for AML-TLD. To evaluate the therapeutic efficacy of allogeneic BMT for AML-TLD, we investigated the clinical data and outcomes of conventional chemotherapy and allogeneic BMT for 118 patients with de novo AML. These patients were registered consecutively for the Japan Adult Leukemia Study Group (JALSG) protocols at our institutes. We treated 28 AML-TLD patients and 90 AML-nonTLD patients with conventional chemotherapeutic protocols. AML-TLD patients did not have a significantly different complete remission (CR) rate (75.0% and 88.4% P = 0.1234), but had a significantly higher relapse rate than AML-nonTLD patients (94.1% and 49.3%, P = 0.0007). The outcome of chemotherapy for AML-TLD was significantly worse than that for AML-nonTLD. The overall survival (OS) and leukemia-free survival (LFS) at 6 years were 9.4% and 0% in AML-TLD group, and 51.9% (P = 0.0017) and 46.3% (P < 0.0001) in AML-nonTLD group, respectively. Meanwhile, among the patients who underwent allogeneic BMT, five of eight AML-TLD patients and eight of 14 AML-nonTLD patients were alive, and three and five patients survived more than 3 years, respectively. These results suggest that allogeneic BMT can improve the outcome for AML-TLD, which is poor when conventional chemotherapy is given alone. Allogeneic BMT before relapse may be the best therapeutic strategy for AML-TLD patients under 50 years of age if a donor is available.

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Acknowledgements

The following institutes participated in this study: Department of Hematology, Nagasaki University Hospital, Nagasaki, Sasebo City General Hospital, Sasebo, Nagasaki-Chuo National Hospital, Ohmura, Nagasaki Municipal Medical Center, Nagasaki and St Francis Hospital, Nagasaki. Allogeneic BMT was performed in Nagasaki University and Sasebo City General Hospital. We are grateful to the JALSG statistical office for providing a portion of the data on AML patients.

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Authors and Affiliations

  1. Department of Hematology and Molecular Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University School of Medicine, Nagasaki, Japan

    J Taguchi, Y Miyazaki, S Yoshida, T Fukushima, I Jinnai, K Kuriyama & M Tomonaga

  2. Sasebo City General Hospital, Sasebo, Japan

    Y Moriuchi

  3. Blood Transfusion Service, Nagasaki University Hospital, Nagasaki, Japan

    T Matsuo

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  1. J Taguchi
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  2. Y Miyazaki
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Taguchi, J., Miyazaki, Y., Yoshida, S. et al. Allogeneic bone marrow transplantation improves the outcome of de novo AML with trilineage dysplasia (AML-TLD). Leukemia 14, 1861–1866 (2000). https://doi.org/10.1038/sj.leu.2401924

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