Extramedullary disease in adult acute myeloid leukemia is common but lacks independent significance: Analysis of patients in ECOG-ACRIN Cancer Research Group trials, 1980-2008 Journal Article


Authors: Ganzel, C.; Manola, J.; Douer, D.; Rowe, J. M.; Fernandez, H. F.; Paietta, E. M.; Litzow, M. R.; Lee, J. W.; Luger, S. M.; Lazarus, H. M.; Cripe, L. D.; Tallman, M. S.
Article Title: Extramedullary disease in adult acute myeloid leukemia is common but lacks independent significance: Analysis of patients in ECOG-ACRIN Cancer Research Group trials, 1980-2008
Abstract: Purpose: Extramedullary disease (EMD) at diagnosis in patients with acute myeloid leukemia (AML) has been recognized for decades. Reported herein are results from a large study of patients with AML who were treated in consecutive ECOG-ACRIN Cancer Research Group frontline clinical trials in an attempt to define the incidence and clinical implications of EMD. Methods: Patients with newly diagnosed AML, age 15 years and older, who were treated in 11 clinical trials, were studied to identify EMD, as defined by physical examination, laboratory findings, and imaging results. Results: Of the 3,522 patients enrolled, 282 were excluded, including patients with acute promyelocytic leukemia, incorrect diagnosis, or no adequate assessment of EMD at baseline. The overall incidence of EMD was 23.7%. The sites involved were: lymph nodes (11.5%), spleen (7.3%), liver (5.3%), skin (4.5%), gingiva (4.4%), and CNS (1.1%). Most patients (65.3%) had only one site of EMD, 20.9% had two sites, 9.5% had three sites, and 3.4% had four sites. The median overall survival was 1.035 years. In univariable analysis, the presence of any EMD (P = .005), skin involvement (P = .002), spleen (P < .001), and liver (P < .001), but not CNS (P = .34), nodal involvement (P = .94), and gingival hypertrophy (P = .24), was associated with a shorter overall survival. In contrast, in multivariable analysis, adjusted for known prognostic factors such as cytogenetic risk and WBC count, neither the presence of EMD nor the number of specific sites of EMD were independently prognostic. Conclusion: This large study demonstrates that EMD at any site is common but is not an independent prognostic factor. Treatment decisions for patients with EMD should be made on the basis of recognized AML prognostic factors, irrespective of the presence of EMD. © 2016 by American Society of Clinical Oncology.
Journal Title: Journal of Clinical Oncology
Volume: 34
Issue: 29
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2016-10-10
Start Page: 3544
End Page: 3553
Language: English
DOI: 10.1200/jco.2016.67.5892
PROVIDER: scopus
PMCID: PMC5074349
PUBMED: 27573652
DOI/URL:
Notes: Article -- Presented as an oral abstract at the American Society of Hematology Annual Meeting which took place December 7-10, 2013 in New Orleans, LA -- Export Date: 2 November 2016 -- Source: Scopus
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MSK Authors
  1. Martin Stuart Tallman
    408 Tallman
  2. Dan Douer
    80 Douer
  3. Chezi Yeehezkel Ganzel
    7 Ganzel