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The leukemia strikes back: a review of pathogenesis and treatment of secondary AML

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Abstract

Secondary AML is associated with a disproportionately poor prognosis, consistently shown to exhibit inferior response rates, event-free survival, and overall survival in comparison with de novo AML. Secondary AML may arise from the evolution of an antecedent hematologic disorder, or it may arise as a complication of prior cytotoxic chemotherapy or radiation therapy in the case of therapy-related AML. Because of the high frequency of poor-risk cytogenetics and high-risk molecular features, such as alterations in TP53, leukemic clones are often inherently chemoresistant. Standard of care induction had long remained conventional 7 + 3 until its reformulation as CPX-351, recently FDA approved specifically for secondary AML. However, recent data also suggests relatively favorable outcomes with regimens based on high-dose cytarabine or hypomethylating agents. With several investigational agents being studied, the therapeutic landscape becomes even more complex, and the treatment approach involves patient-specific, disease-specific, and therapy-specific considerations.

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  1. Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, 1540 E. Hospital Drive, Room CW 7-251B, Ann Arbor, MI, 48109-2054, USA

    Edna Cheung, Anthony J. Perissinotti, Lydia L. Benitez, Julia Brown, Gianni B. Scappaticci & Bernard L. Marini

  2. Department of Internal Medicine, Division of Hematology/Oncology, Adult BMT and Leukemia Programs, Michigan Medicine and University of Michigan Medical School, 1500 E. Medical Center Dr. UHS F4811, Ann Arbor, MI, USA

    Dale L. Bixby, Patrick W. Burke & Kristen M. Pettit

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Cheung, E., Perissinotti, A.J., Bixby, D.L. et al. The leukemia strikes back: a review of pathogenesis and treatment of secondary AML. Ann Hematol 98, 541–559 (2019). https://doi.org/10.1007/s00277-019-03606-0

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