Investigational Approaches

As noted above, it is unlikely that secondary AML/ MDS possesses unique therapeutic targets. Indeed, because the chromosomal abnormalities characteristic of secondary AML/MDS more frequently occur in older than in younger patients with de novo AML, many of the former may really have "secondary" AML, consequent to prolonged exposure to toxins. Similarly, many patients considered to have de novo AML would be classified as having secondary AML had they happened to visit a physician and have an AHD detected in the months before they were found to have AML. Given these facts, a discussion of investigational approaches to secondary AML is in reality a general discussion of such approaches in worse prognosis AML/MDS. As the ability of the patient to withstand therapy is an important consideration and is often a

Table 7.3 Outcome in patients under age 60 with performance status 0-2 by cytogenetics and de novo versus secondary distinction

De novo cases Secondary cases

Cytogenetics CR rate RFS at 2 years CR rate RFS at 2 years

Intermediate prognosis 264/352 (75%) 0.36 120/196 (61%) 0.27

Outcome in patients of age 60 and above with performance status 0-2 by cytogenetics and de novo versus secondary distinction
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