Atypical chronic myeloid leukemia is clinically distinct from unclassifiable myelodysplastic/myeloproliferative neoplasms

Sa A. Wang, Robert P. Hasserjian, Patricia S. Fox, Heesun J. Rogers, Julia T. Geyer, Devon Chabot-Richards, Elizabeth Weinzierl, Joseph Hatem, Jesse Jaso, Rashmi Kanagal-Shamanna, Francesco C. Stingo, Keyur P. Patel, Meenakshi Mehrotra, Carlos Bueso-Ramos, Ken H. Young, Courtney D. Dinardo, Srdan Verstovsek, Ramon V. Tiu, Adam Bagg, Eric D. HsiDaniel A. Arber, Kathryn Foucar, Raja Luthra, Attilio Orazi

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Abstract

Atypical chronic myeloid leukemia (aCML) is a rare subtype of myelodysplastic/ myeloproliferative neoplasm (MDS/MPN) largely defined morphologically. It is, unclear, however, whether aCML-associated features are distinctive enough to allow its separation from unclassifiableMDS/MPN(MDS/MPN-U) .Tostudy these 2 rare entities, 134 patient archives were collected from 7 large medical centers, of which 65 (49%) cases were further classified asaCMLand the remaining 69 (51%) asMDS/MPN-U. Distinctively,aCML was associated with many adverse features and an inferior overall survival (12.4 vs 21.8 months, P 5 .004) and AML-free survival (11.2 vs 18.9 months, P 5 .003). The aCML defining features of leukocytosis and circulating myeloid precursors, but not dysgranulopoiesis, were independent negative predictors. Other factors, such as lactate dehydrogenase, circulating myeloblasts, platelets, and cytogenetics could further stratify MDS/ MPN-U but not aCML patient risks. aCML appeared to have more mutated RAS (7/20 [35%] vs 4/29 [14%]) and less JAK2p.V617F (3/42 [7%] vs 10/52 [19%]), but was not statistically significant. Somatic CSF3R T618I (0/54) and CALR (0/30) mutations were not detected either in aCML or MDS/MPN-U. In conclusion, within MDS/MPN, the World Health Organization 2008 criteria for aCML identify a subgroup of patients with features clearly distinct from MDS/MPN-U. The MDS/MPN-U category is heterogeneous, and patient risk can be further stratified by a number of clinicopathological parameters.

Original languageEnglish (US)
Pages (from-to)2645-2651
Number of pages7
JournalBlood
Volume123
Issue number17
DOIs
StatePublished - Apr 24 2014

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ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

Wang, S. A., Hasserjian, R. P., Fox, P. S., Rogers, H. J., Geyer, J. T., Chabot-Richards, D., Weinzierl, E., Hatem, J., Jaso, J., Kanagal-Shamanna, R., Stingo, F. C., Patel, K. P., Mehrotra, M., Bueso-Ramos, C., Young, K. H., Dinardo, C. D., Verstovsek, S., Tiu, R. V., Bagg, A., ... Orazi, A. (2014). Atypical chronic myeloid leukemia is clinically distinct from unclassifiable myelodysplastic/myeloproliferative neoplasms. Blood, 123(17), 2645-2651. https://doi.org/10.1182/blood-2014-02-553800