Leukemia Cutis Affects Overall Survival in Acute Myeloid Leukemia

Acute myeloid leukemia
Acute myeloid leukemia
Investigators assessed the impact leukemia cutis has on overall survival, leukemia-specific survival, and 5-year overall survival rates in patients with acute myeloid leukemia.

For patients with acute myeloid leukemia, the presentation of leukemia cutis decreases overall survival (OS) and leukemia-specific survival, according to study results published in JAMA Dermatology.

Researchers of this retrospective, matched-cohort study used Washington University School of Medicine’s databases to evaluate the effect leukemia cutis has on OS, leukemia-specific survival, and 5-year OS rates in patients with acute myeloid leukemia. Patients with biopsy-confirmed leukemia cutis were matched to patients without leukemia cutis, and information pertaining to diagnoses, comorbidities, and causes of death was gathered using electronic medical records. Propensity score matching was used to evaluate the differences in survival rates of the 2 cohorts.

After matching, 62 patients were included in the acute myeloid leukemia with leukemia cutis cohort and 186 patients were included in the acute myeloid leukemia without leukemia cutis cohort. The standardized mean differences between the 2 cohorts for all matched covariates were <0.1. For the cohort with leukemia cutis, the median OS was 13.03 months (95% CI, 10.02-16.62 months), the median leukemia-specific survival was 13.86 months (95% CI, 10.02-17.74 months), and the 5-year OS rate was 8.6%. The cohort without leukemia cutis had a significantly longer median OS of 17.21 months (95% CI, 13.54-21.26 months; P =.01), a significantly longer median leukemia-specific survival of 22.21 months (95% CI, 17.05-42.51 months; P =.002), and a higher 5-year OS rate of 28.3%. The cohort with leukemia cutis had an odds ratio of 3.48 (95% CI, 1.72-7.05; P <.001) for other extramedullary organ involvement and 2.13 (95% CI, 1.10-4.12; P =.03) for the chromosomal aberration of an additional chromosome 8. Multivariate analysis indicated a hazard ratio of 2.06 (95% CI, 1.26-3.38; P =.004) for leukemia-specific death and 1.66 (95% CI, 1.06-2.60; P =.03) for all-cause death for patients with leukemia cutis compared with those patients without leukemia cutis.

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Limitations of this study include the retrospective nature of this study, the small sample size, and disease classifications according to the French-American-British criteria.

The researchers concluded that “leukemia cutis is associated with a poor prognosis for patients with systemic acute myeloid leukemia and that these patients may require more aggressive treatment and intensive monitoring throughout their clinical course.”

Dr Anadkat reported multiple associations with pharmaceutical companies. Please see the original reference for a full list of the author’s disclosures.

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Wang CX, Pusic I, Anadkat MJ. Association of leukemia cutis with survival in acute myeloid leukemia [published online April 10, 2019]. JAMA Dermatol. doi: 10.1001/jamadermatol.2019.0052