Allogeneic bone marrow transplantation improves the outcome of de novo AMLwith trilineage dysplasia (AML-TLD)

De novo acute myeloid leukemia (AML) with dysplastic features in erythrobla sts, granulocytes and megakaryocytes, similar to those in myelodysplastic s yndrome (MDS) has been described as AML with trilineage dysplasia (AML-TLD) since 1987, Several reports have suggested that AML-TLD is a subtype of de novo AML in adults and has a poor clinical outcome when treated by convent ional chemotherapy. It is not certain whether allogeneic bone marrow transp lantation (BMT) brings a favorable outcome for AML-TLD. To evaluate the the rapeutic efficacy of allogeneic BMT for AML-TLD, we investigated the clinic al data and outcomes of conventional chemotherapy and allogeneic BMT for 11 8 patients with de novo AML. These patients were registered consecutively f or the Japan Adult Leukemia Study Group (JALSG) protocols at our institutes . We treated 28 AML-TLD patients and 90 AML-nonTLD patients with convention al chemotherapeutic protocols. AML-TLD patients did not have a significantl y different complete remission (CR) rate (75.0% and 88.4% P = 0.1234), but had a significantly higher relapse rate than AML-nonTLD patients (94.1% and 49.3%, P= 0.0007). The outcome of chemotherapy for AML-TLD was significant ly worse than that for AML-nonTLD. The overall survival (OS) and leukemia-f ree survival (LFS) at 6 years were 9.4% and 0% in AML-TLD group, and 51.9% (P = 0.0017) and 46.3% (P < 0.0001) in AML-nonTLD group, respectively. Mean while, among the patients who underwent allogeneic BMT, five of eight AML-T LD patients and eight of 14 AML-nonTLD patients were alive, and three acid five patients survived more than 3 years, respectively. These results sugge st that allogeneic BMT can improve the outcome for AML-TLD, which is poor w hen conventional chemotherapy is given alone. Allogeneic BMT before relapse may be the best therapeutic strategy for AML-TLD patients under 50 years o f age if a donor is available.