Acute Myeloid Leukemia Biological and Clinical Features of Trisomy 21 in Adult Patients With Acute Myeloid Leukemia

In non-Down syndrome (DS) adult acute myeloid leukemia (AML), trisomy 21 (D21) has traditionally been classified as intermediate-risk cytogenetic. We analyzed 90 adult patients with non-DS D21 AML treated be- tween 1995 and 2011. Our analysis revealed that isolated D21 or D21 with favorable cytogenetic anomalies hitherto classified as intermediate-risk might in fact behave as favorable-risk cytogenetics in adult AML patients. Introduction: Trisomy 21 is frequently noted in patients with AML. In adults, þ21 has traditionally been considered an intermediate-risk cytogenetic aberration. Patients and Methods: We analyzed 90 patients with newly diagnosed AML harboring þ21. Four cytogenetic subgroups were defined based on associated cytogenetic abnormalities: þ21 alone, þ21 with favorable, þ21 with intermediate, and þ21 with unfavorable cytogenetics. Results: Fifty-four percent of patients with þ21 AML achieved a complete remission (CR) or CR with incomplete platelet recovery (CRp) after induction therapy with a trend toward improved CR/CRp rates in patients with þ21 alone/þ21 with favorable cyto- genetics compared with patients with þ21 with intermediate/þ21 with unfavorable cytogenetics (76% vs. 50%; P ¼ .057). Time to progression (TTP) was 12 months (range, 5-19) and overall survival (OS) was 9 months (range, 7-11) for the entire group. TTP was longer for patients with þ21 alone (not reached) or with þ21 with favorable cytogenetics (101 months) compared with those with þ21 with intermediate cytogenetics (2 months) or þ21 with unfavorable cytogenetics (11 months) (P ¼ .02). Similarly, OS was improved in patients with þ21 with favorable cytogenetics (not reached) or þ21 alone (107 months), compared with þ21 with unfavorable cytogenetics (9 months) or þ21 with in- termediate cytogenetics (8 months) (P < .001). The differences in TTP and OS were maintained on multivariate analysis (P ¼ .04 and P ¼ .001; respectively). Conclusion: Isolated þ21 hitherto classified as intermediate-risk cytogenetics might actually behave as a favorable-risk cytogenetics in adult AML patients.

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