Azacitidine front-line in 339 patients with myelodysplastic syndromes and acute myeloid leukaemia: comparison of French-American-British and World Health Organization classifications
Abstract Background The MDS-IWG and NCCN currently endorse both FAB and WHO classifications of MDS and AML, thus allowing patients with 20–30 % bone marrow blasts (AML20–30, formerly MDS-RAEB-t) to be categorised and treated as either MDS or AML. In addition, an artificial distinction between AML20–...
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2016-04-01
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| Series: | Journal of Hematology & Oncology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13045-016-0263-4 |
| _version_ | 1818139934886723584 |
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| author | Lisa Pleyer Sonja Burgstaller Reinhard Stauder Michael Girschikofsky Heinz Sill Konstantin Schlick Josef Thaler Britta Halter Sigrid Machherndl-Spandl Armin Zebisch Angelika Pichler Michael Pfeilstöcker Eva-Maria Autzinger Alois Lang Klaus Geissler Daniela Voskova Dietmar Geissler Wolfgang R. Sperr Sabine Hojas Inga M. Rogulj Johannes Andel Richard Greil |
| author_facet | Lisa Pleyer Sonja Burgstaller Reinhard Stauder Michael Girschikofsky Heinz Sill Konstantin Schlick Josef Thaler Britta Halter Sigrid Machherndl-Spandl Armin Zebisch Angelika Pichler Michael Pfeilstöcker Eva-Maria Autzinger Alois Lang Klaus Geissler Daniela Voskova Dietmar Geissler Wolfgang R. Sperr Sabine Hojas Inga M. Rogulj Johannes Andel Richard Greil |
| author_sort | Lisa Pleyer |
| collection | DOAJ |
| description | Abstract Background The MDS-IWG and NCCN currently endorse both FAB and WHO classifications of MDS and AML, thus allowing patients with 20–30 % bone marrow blasts (AML20–30, formerly MDS-RAEB-t) to be categorised and treated as either MDS or AML. In addition, an artificial distinction between AML20–30 and AML30+ was made by regulatory agencies by initially restricting approval of azacitidine to AML20–30. Thus, uncertainty prevails regarding the diagnosis, prognosis and optimal treatment timing and strategy for patients with AML20–30. Here, we aim to provide clarification for patients treated with azacitidine front-line. Methods The Austrian Azacitidine Registry is a multicentre database (ClinicalTrials.gov: NCT01595295). For this analysis, we selected 339 patients treated with azacitidine front-line. According to the WHO classification 53, 96 and 190 patients had MDS-RAEB-I, MDS-RAEB-II and AML (AML20–30: n = 79; AML30+: n = 111), respectively. According to the FAB classification, 131, 101 and 111 patients had MDS-RAEB, MDS-RAEB-t and AML, respectively. Results The median ages of patients with MDS and AML were 72 (range 37–87) and 77 (range 23–93) years, respectively. Overall, 80 % of classifiable patients (≤30 % bone marrow blasts) had intermediate-2 or high-risk IPSS scores. Most other baseline, treatment and response characteristics were similar between patients diagnosed with MDS or AML. WHO-classified patients with AML20–30 had significantly worse OS than patients with MDS-RAEB-II (13.1 vs 18.9 months; p = 0.010), but similar OS to patients with AML30+ (10.9 vs 13.1 months; p = 0.238). AML patients that showed MDS-related features did not have worse outcomes compared with patients who did not (13.2 vs 8.9 months; p = 0.104). FAB-classified patients with MDS-RAEB-t had similar survival to patients with AML30+ (12.8 vs 10.9 months; p = 0.376), but significantly worse OS than patients with MDS-RAEB (10.9 vs 24.4 months; p < 0.001). Conclusions Our data demonstrate the validity of the WHO classification of MDS and AML, and its superiority over the former FAB classification, for patients treated with azacitidine front-line. Neither bone marrow blast count nor presence of MDS-related features had an adverse prognostic impact on survival. Patients with AML20–30 should therefore be regarded as having ‘true AML’ and in our opinion treatment should be initiated without delay. |
| first_indexed | 2024-12-11T10:35:59Z |
| format | Article |
| id | doaj.art-b40b7ac28a984159b4bb8b27ecd44658 |
| institution | Directory Open Access Journal |
| issn | 1756-8722 |
| language | English |
| last_indexed | 2024-12-11T10:35:59Z |
| publishDate | 2016-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Hematology & Oncology |
| spelling | doaj.art-b40b7ac28a984159b4bb8b27ecd446582022-12-22T01:10:43ZengBMCJournal of Hematology & Oncology1756-87222016-04-019111610.1186/s13045-016-0263-4Azacitidine front-line in 339 patients with myelodysplastic syndromes and acute myeloid leukaemia: comparison of French-American-British and World Health Organization classificationsLisa Pleyer0Sonja Burgstaller1Reinhard Stauder2Michael Girschikofsky3Heinz Sill4Konstantin Schlick5Josef Thaler6Britta Halter7Sigrid Machherndl-Spandl8Armin Zebisch9Angelika Pichler10Michael Pfeilstöcker11Eva-Maria Autzinger12Alois Lang13Klaus Geissler14Daniela Voskova15Dietmar Geissler16Wolfgang R. Sperr17Sabine Hojas18Inga M. Rogulj19Johannes Andel20Richard Greil213rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University SalzburgDepartment of Internal Medicine IV, Klinikum Wels-GrieskirchenDepartment of Internal Medicine V, Innsbruck Medical UniversityDepartment of Hematology and Oncology, Elisabethinen HospitalDepartment of Hematology, Medical University of Graz3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University SalzburgDepartment of Internal Medicine IV, Klinikum Wels-GrieskirchenDepartment of Internal Medicine V, Innsbruck Medical UniversityDepartment of Hematology and Oncology, Elisabethinen HospitalDepartment of Hematology, Medical University of GrazDepartment for Hematology and Oncology, LKH Leoben3rd Medical Department for Hematology and Oncology, Hanusch HospitalFirst Medical Department, Center for Oncology, Hematology and Palliative Care, WilhelminenspitalDepartment of Internal Medicine, LKH Feldkirch5th Medical Department, Hospital HietzingDepartment of Internal Medicine III, General Hospital1st Medical department, Klinikum KlagenfurtDepartment of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of ViennaDepartment of Internal Medicine, LKH FürstenfeldDepartment of Hematology, Clinical Hospital MerkurDepartment of Internal Medicine II, LKH Steyr3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University SalzburgAbstract Background The MDS-IWG and NCCN currently endorse both FAB and WHO classifications of MDS and AML, thus allowing patients with 20–30 % bone marrow blasts (AML20–30, formerly MDS-RAEB-t) to be categorised and treated as either MDS or AML. In addition, an artificial distinction between AML20–30 and AML30+ was made by regulatory agencies by initially restricting approval of azacitidine to AML20–30. Thus, uncertainty prevails regarding the diagnosis, prognosis and optimal treatment timing and strategy for patients with AML20–30. Here, we aim to provide clarification for patients treated with azacitidine front-line. Methods The Austrian Azacitidine Registry is a multicentre database (ClinicalTrials.gov: NCT01595295). For this analysis, we selected 339 patients treated with azacitidine front-line. According to the WHO classification 53, 96 and 190 patients had MDS-RAEB-I, MDS-RAEB-II and AML (AML20–30: n = 79; AML30+: n = 111), respectively. According to the FAB classification, 131, 101 and 111 patients had MDS-RAEB, MDS-RAEB-t and AML, respectively. Results The median ages of patients with MDS and AML were 72 (range 37–87) and 77 (range 23–93) years, respectively. Overall, 80 % of classifiable patients (≤30 % bone marrow blasts) had intermediate-2 or high-risk IPSS scores. Most other baseline, treatment and response characteristics were similar between patients diagnosed with MDS or AML. WHO-classified patients with AML20–30 had significantly worse OS than patients with MDS-RAEB-II (13.1 vs 18.9 months; p = 0.010), but similar OS to patients with AML30+ (10.9 vs 13.1 months; p = 0.238). AML patients that showed MDS-related features did not have worse outcomes compared with patients who did not (13.2 vs 8.9 months; p = 0.104). FAB-classified patients with MDS-RAEB-t had similar survival to patients with AML30+ (12.8 vs 10.9 months; p = 0.376), but significantly worse OS than patients with MDS-RAEB (10.9 vs 24.4 months; p < 0.001). Conclusions Our data demonstrate the validity of the WHO classification of MDS and AML, and its superiority over the former FAB classification, for patients treated with azacitidine front-line. Neither bone marrow blast count nor presence of MDS-related features had an adverse prognostic impact on survival. Patients with AML20–30 should therefore be regarded as having ‘true AML’ and in our opinion treatment should be initiated without delay.http://link.springer.com/article/10.1186/s13045-016-0263-4AMLMDSWHOFABClassificationRAEB-t |
| spellingShingle | Lisa Pleyer Sonja Burgstaller Reinhard Stauder Michael Girschikofsky Heinz Sill Konstantin Schlick Josef Thaler Britta Halter Sigrid Machherndl-Spandl Armin Zebisch Angelika Pichler Michael Pfeilstöcker Eva-Maria Autzinger Alois Lang Klaus Geissler Daniela Voskova Dietmar Geissler Wolfgang R. Sperr Sabine Hojas Inga M. Rogulj Johannes Andel Richard Greil Azacitidine front-line in 339 patients with myelodysplastic syndromes and acute myeloid leukaemia: comparison of French-American-British and World Health Organization classifications Journal of Hematology & Oncology AML MDS WHO FAB Classification RAEB-t |
| title | Azacitidine front-line in 339 patients with myelodysplastic syndromes and acute myeloid leukaemia: comparison of French-American-British and World Health Organization classifications |
| title_full | Azacitidine front-line in 339 patients with myelodysplastic syndromes and acute myeloid leukaemia: comparison of French-American-British and World Health Organization classifications |
| title_fullStr | Azacitidine front-line in 339 patients with myelodysplastic syndromes and acute myeloid leukaemia: comparison of French-American-British and World Health Organization classifications |
| title_full_unstemmed | Azacitidine front-line in 339 patients with myelodysplastic syndromes and acute myeloid leukaemia: comparison of French-American-British and World Health Organization classifications |
| title_short | Azacitidine front-line in 339 patients with myelodysplastic syndromes and acute myeloid leukaemia: comparison of French-American-British and World Health Organization classifications |
| title_sort | azacitidine front line in 339 patients with myelodysplastic syndromes and acute myeloid leukaemia comparison of french american british and world health organization classifications |
| topic | AML MDS WHO FAB Classification RAEB-t |
| url | http://link.springer.com/article/10.1186/s13045-016-0263-4 |
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