Analysis and clinical characteristics of acute myeloid leukemia developing with prior or concurrent tumors in non cyto- or radiotherapy exposure patients in a single center

Figures & data

Figure 1. Distribution of different types of multiple neoplasms. A. Incidence of tAML, AHD-AML, pc-AML, pc-MDS, and rare cases. B. Descriptive data on the relationship between prior exposure and secondary disorders. C. The types of secondary hematological malignancies after previous solid tumors in rare cases. Abbreviations: HM, hematological malignancy; ST, solid tumor; tAML, therapy-related acute myeloid leukemia; AHD-AML, AML discovered following a prior hematologic disorder; pc-AML and pc-MDS, AML and MDS developing with an antecedent or simultaneous tumors without prior cytotoxic or radio-therapy.

Figure 2. Latency time from first hospital contact for the preceding disease to the date of the secondary neoplasms in tAML (A), pc-AML(B), AHD-AML(C), and rare cases(D). Abbreviations: AML, acute myeloid leukemia; MDS, myelodysplastic syndrome; MPN, myeloproliferative neoplasms; ET, primary thrombocytosis; CMML, chronic myelomonocytic leukemia; APL, acute promyelocytic leukemia; HAL, hybrid acute leukemia; ALL, acute lymphoblastic leukemia; NHL, non-Hodgkin’s lymphoma; MCL, mantle cell lymphoma; DLBCL, diffuse large B-cell lymphoma.

Figure 3. Distribution of previous disease in 5 patients with tAML(A), 15 patients with pc-AML(B), and 16 patients with AHD-AML(C).

Table 1. Patient Characteristics.

Characteristics	tAML(N = 5)	pc-AML(N = 15)	AHD-AML(N = 15)
M/F ratio	0.67	2	1.5
median age, years	43	66	63
Range	34–76	28–76	49–88
Latency time, months	46 (35-94)	34 (0-276)	30 (4-187)
WBC count, × 10^9/L	1.91	5.35	2.05
Range	0.70-37.70	0.60-247.20	0.50-157.60
Platelet count, × 10^9/L	34 (23-41)	30 (6-284)	38.5 (10.0-204.0)
LDH level, U/L	154.9	418.7	353.2
Range	91.9-303.1	81.5-2986.5	123.0-575.1
Cytogenetics
Favorable	1 (20%)	0	0
Intermediate	1 (20%)	8 (53%)	1 (7%)
Adverse	3 (60%)	6 (41%)	13 (87%)
Not available	0	1 (6%)	1 (7%)
Cytogenetics (karyotype)
Normal karyotype	0	9 (60%)	4 (26%)
Abnormal karyotype	4 (80%)	5 (33%)	10 (67%)
Not available	1 (20%)	1 (7%)	1 (7%)

AML: acute myeloid leukemia; t-AML: therapy-related AML; pc-AML: AML that develops along with prior or concurrent tumors without previous cyto- or radiotherapy; AHD-AML: AML discovered following prior hematologic disorders; M: male; F: female; WBC: white blood cells; LDH: lactate dehydrogenase.

Figure 4. The mutational profiles among pc-AML, tAML, and AHD-AML of 55 genes associated with myeloid neoplasms. A Total of 31 types and a total number of 91 gene mutations are shown.

Figure 5. The category of mutation profiles by molecular functions for the progression of AML among pc-AML, tAML, and AHD-AML.

Figure 6. The response rate and overall survival rate. The response rate (CR/CRi rates) among pc-AML, tAML, and AHD-AML patients (A) and the response rate in three types of secondary AML patients with HMAs + VEN-based and IC-based regimens (B). Probabilities of overall survival (OS) in pc-AML compared with tAML and AHD-AML patients (C), and OS in three types of secondary AML patients with HMAs + VEN-based and IC-based regimens (D). Abbreviations: CR, complete remission; CRi, CR with incomplete blood count recovery; HMAs + VEN, hypomethylating agents in combination with venetoclax; IC, intensive chemotherapy.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.