Risk assessment in human immunodeficiency virus-associated acute myeloid leukemia

Abstract

CD4 count ≤200×10⁶ cells/L has been identified as a predictor of short survival in HIV-associated acute myeloid leukemia (HIV-AML), but karyotype, which is the best predictor of survival in AML, has not been evaluated in HIV-AML patients. A retrospective cohort of 31 patients was created from 9 local cases and 22 published cases. HIV-AML karyotypes were heterogeneous and were similar in distribution to those in HIV-negative AML. Among intensively treated patients, most achieved complete remission, but succumbed to infectious complications, mostly non-opportunistic, during consolidation therapy. Median survival for intensively-treated patients with CD4 counts ≤200×10⁶ cells/L was 8.5 months, compared to 48 months for those with >200×10⁶ CD4 cells/L (p=0.03). In contrast, AML karyotype did not predict survival (p=0.43), albeit with small numbers in each karyotype group. Thus, CD4 count is a strong predictor of short survival in HIV-AML patients regardless of karyotype. Studies evaluating innovative strategies for infection prophylaxis and for improving immune reconstitution are needed.

Keywords::

• Human immunodeficiency virus
• acquired immunodeficiency syndrome
• acute myeloid leukemia
• risk assessment

Acknowledgements

We acknowledge the contributions of the staff at both the University of Maryland Greenebaum Cancer Center and Johns Hopkins Sidney Kimmel Comprehensive Cancer Center and NCI Cancer Center Support Grants P30 CA134274 and 2P30 CA 06973-46.

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