IMPACT OF HIGH-RISK CYTOGENETICS ON THE SURVIVAL OF NON-APL ACUTE MYELOID LEUKEMIA PATIENTS

Abstract

Acute myeloid leukemia (AML) is a hematologic malignancy characterized by the rapid proliferation of abnormal myeloid cells in the bone marrow and peripheral blood. Cytogenetics plays a crucial role in the risk stratification and prognosis of AML patients, according to the latest guidelines from the World Health Organization (WHO) and the European LeukemiaNet (ELN). This study aims to analyze the impact of high-risk cytogenetics on the survival of non-promyelocytic AML (non-APL) patients. In all, 93 non-APL AML patients were diagnosed between July 2021 and June 2024 at the Hospital Geral de Fortaleza (HGF), which is the largest oncohematology outpatient clinic in the state of Ceará. Survival data from non-APL AML patients were analyzed, stratified according to the presence or absence of high-risk cytogenetics, according to the guidelines. The analysis was performed using the Kaplan-Meier method, comparing two groups: patients with high-risk cytogenetics and patients without high-risk cytogenetics. Among the 93 patients, 47 were women and 46 were men, with a median age of 52.9 years (17-96 years). It was not possible to stratify all patients due to the lack of cytogenetic results. Among the available results, it was possible to stratify 15 patients with high-risk cytogenetic and 38 without high-risk cytogenetic. Herewith, a significant difference in the probability of survival was observed between the two groups over time, where the group with high-risk cytogenetics demonstrated a sharp drop in the probability of survival in the first 10 months, with a very low residual survival after this period, while the group that was not high-risk had a higher and more stable survival rate over time, with a probability of survival greater than 75% at 40 months. The results indicate that the presence of high-risk cytogenetics is associated with a significant worsening in overall survival of non-APL AML patients. Patients with high-risk cytogenetics show a rapid and marked decrease in the probability of survival in the first 10 months after diagnosis, underscoring the need for more aggressive and personalized therapeutic strategies for this subgroup. This occurs similarly in the literature that points to adverse cytogenetic abnormalities, such as in acute myeloid leukemia and chronic lymphocytic leukemias. These findings reinforce the importance of cytogenetic stratification in the clinical AML management. Patients with high-risk cytogenetics have a worse survival, which warrants more intensive therapeutic interventions and close monitoring. Cytogenetics-based risk stratification should be standard practice in treatment assessment and planning.