Evaluation of Prognostic Factors Involved in the Evolution of Secondary Acute Leukemia Patients

Secondary acute leukemia (sAL) has a worse prognosis, with severe evolution and higher risk of sepsis. Previous chemotherapy could cause genetic mutations that influenced the prognosis of sAL.

To identify prognostic factors in patients with sAL.

A retrospective study from 2015-2024 included 109 patients with acute leukemia diagnosed in the Hematology Clinic of the Colentina Clinical Hospital. The study group included 69 patients with secondary acute leukemia: 39 patients with chronic hematologic neoplasms and 30 patients with solid tumors. We enrolled a control group that included 40 patients without neoplasia in their medical history. The analyzed variables were Flow cytometry markers: CD56, CD71, CD 123, CD7, CD9; cytogenetic and molecular markers, hematological and biochemical parameters.

Aberrant expression of CD56, CD7, CD9, CD71 and CD123 influenced the survival of patients with sAL, the chi-squared of overall model fit is 13.61, p=0.01. The most important marker is CD71 expression, the median survival in the patient group is 3 months (95% for median-1-9 months) vs 14 months (95%Ci for median-5-60 months) in the control group, p = 0.0006. We obtained no significant differences in cytogenetic or molecular marker for survival analyses. Patients with sAL followed by solid tumor have more blasts in the bone marrow than patients with chronic hematological neoplasms with a median value 43% , average rank =19.63 vs 75% average rank= 28.5, p=0.02. The severity of neutropenia is more important in patients with sAl with solid tumor in their history than in patients with chronic hematologic neoplasia, with a median value 1.15, average rank 28,96 vs 2.72 average rank =37,61, p=0, 05. Probably because of neutropenia, patients with solid tumors have higher values of C-reactive protein (CRP) and fibrinogen and more frequent severe infections that influenced the evolution of patients.

Patients with solid tumor in the medical history have an aggressive form of acute leukemia at onset represented by severe neutropenia and with higher frequency of inflammatory markers, higher rate of bone marrow blasts. The presence of CD71, CD56, Cd7, CD9 and CD 123 expression could indicate the worst evolution of sAL patients.

Popov:Colentina Clinical Hospital: Current Employment.