Outcomes of Acute Myeloid Leukemia (AML) from Myeloproliferative Neoplasms (MPN) Compared with Primary AML: A Retrospective Database Analysis
Authors: Kasire Sripada Preetham , Mylavarapu Maneeth , Tufail Mohammad Umer , Bhanushali Charmi , Jayakumar Jayalekshmi , Babu Kalaivani , Babu Kalaivani , Rajarajan Srinishant , Guntuku Sandeep , Iqbal Rabia , Roy Arya Mariam 
Published: December 2024

Background:

Myeloproliferative Neoplasms (MPN) comprise of heterogenous group of clonal myeloid stem cell disorders comprising of polycythemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis (PMF). These disorders are associated with thrombotic complications and leukemic transformation. In this study, we aim to compare the Acute Myeloid Leukemia (AML) arising from MPN vs primary AML using various patient demographics and characteristics and comparing outcomes.

Methods:

This is a retrospective cohort analysis of the National Inpatient Sample (NIS) data 2016 - 2020. Adult patients with the diagnosis of Acute Myeloid Leukemia (AML) and Myeloproliferative Neoplasms (MPN) including PV, ET and PMF were included using ICD-10 codes. Univariate and multivariate regression analysis models were used to adjust for potential confounders such as age, gender, race, income quartile, hospital location, region, teaching status and hospital bed size. The primary outcome measured is the mortality and the secondary outcomes include length of stay (LOS), total hospitalization cost, tumor lysis syndrome (TLS), acute MI (AMI), stroke, anemia, thrombocytopenia, major bleeding, venous thromboembolism (VTE). Statistical analysis is performed using the data software STATA 18.0. A p-value ≤ 0.05 is considered statistically significant.

Results:

Out of 258,895 AML hospitalizations, 4,770 (1.84%) had concurrent MPNs. The MPN group were relatively older (67 years) compared to primary AML subgroup (58.4 years). Amongst the various subtypes of MPN, primary myelofibrosis (PMF) had highest prevalence (45.1%), followed by essential thrombocythemia (ET) (33.3%), and polycythemia vera (PV) (21.6%). The AML arising from MPNs had a significantly higher mortality (12.89% vs 8.39%) when compared to the primary AML. Among MPNs subtypes, AML associated with PV had highest mortality (14.6%), followed by PMF (13.17%), and ET (11.27%).

The odds ratio of mortality in MPN group is 1.61 (95% CI 1.34 - 1.94; p&lt;0.0001) and the adjusted odds ratio after adjusting for the common confounders using univariate and multivariate regression analysis is 1.36 (95% CI 1.12 - 1.64; p=0.02). Among secondary outcomes, there is significant increase in TLS (5.14% vs 3.56%, p = 0.008), however there is no statistically significant difference between both the groups for LOS (12.42 vs 12.67), total hospitalization cost (164,193$ vs 166,025$) stroke (1.26 vs 1.07%), AMI (2.8% vs 2.2%), sepsis (19.4% vs 18.2%), major bleeding (2.94% vs 2.13%).

Conclusions:

This study highlights the distinct demographic and clinical profile of AML patients with concurrent MPN, characterized by an older age at diagnosis and varied MPN subtypes. The study shows that there is a higher mortality and TLS associated with AML arising from MPN across all types of MPN compared to primary AML. This highlights the importance of monitoring patients with MPN closely for progression to AML. Further research is required to understand the underlying mechanisms for this difference and optimize treatment options to specifically target the AML arising from MPN.