Prior Stem Cell Insult

Older adults with AML are more likely to have a secondary leukemia arising from an antecedent MDS or from prior therapy with chemotherapy or radiation therapy for another cancer.23 24 Patients with this type of AML are predisposed to having abnormalities in chromosome 5 and/or 7.12'14 Secondary AML (AML that arose after MDS, myeloproliferative disorders, and therapies or other malignancies) comprises 24-56% of AML diagnoses in older patients.8'22 25 Compare this to the prevalence of approximately 8% in younger AML patients in the MRC AML 10 trial.12 AML arising from prior bone marrow stem cell disorders, particularly when the process is greater than 10 months in duration prior to the development of AML, is less responsive to chemotherapy, resulting in shorter event-free survival, a lower CR rate, and conferring a worse prognosis.26

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