Leukemic Transformation Of

Leukemic transformation of MMM occurs in approximately 10-15% of patients,100 and is usually fatal. A recent series of 91 consecutive MMM patients101 who underwent LT reported that transformation was usually clinically heralded by organomegaly, worsening constitutional symptoms, anemia, thrombocytopenia, and leukocytosis. At the diagnosis of MMM, these patients had frequently presented with typical disease-related features, but about half had an increase in circulating myeloblasts. All episodes of LT were acute myeloid leukemia, with all French-American-British subtypes represented except M3. Additionally, 91% of patients displayed an abnormal karyotype. LT from MMM was usually fatal, with 89 patients (98%) having expired of disease or therapy a median of 2.6 months (range 0-24.2) after LT. Supportive care alone or noninduction chemotherapy had similar outcomes in 48 patients and 19 patients, respectively (median survival <3 months in both groups). Induction chemotherapy in 24 patients (26%) had a 33% mortality with no complete remissions achieved [median survival 3.4 months (range 0.9-24.3)]. However, a subset of patients (n = 10; 41%) reverted their marrow to a chronic phase of MMM after induction. Salvage regimens for nonresponders were overall unsuccessful. The outcome of LT in MMM with current therapies is dismal. Either supportive care alone or appropriate clinical trials should be considered.

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