| ObjectiveTo investigate the clinical characteristics and outcome of adult patients with newly diagnosed hyerleukocytic acute myeloid leukemia(HAML). And the outcome of this subset of patients was compared with patients with non-hyperleukocytic acute myeloid leukemia(NHAML).MethodsData of 66 de novo HAML (non M3) patients presenting to our hospital between January 1,1998 and December 31,2008 were retrospectively reviewed. The outcome of these patients was compared with 202 de novo NHAML patients randomly selected admitted in the same period. Data were analyzed with the SPSS15.0 software.Results1. From January 1998 to December 2008,66 de novo HAML cases of patients and 202 de novo NHAML patients randomly selected were recorded. The median age of HAML patients was 38.5 years (range 15-83), including 36 males and 27 females. The patients were classified based on the FAB criteria, including 4,10,9,3,9 and 31 cases in M1,M2,M4,M4EO,M5a and M5b respectively, mainly M4/M5(78.8%)。The median age of NHAML patients was 38.0 years (range 16-68), including 107 males and 95 females. According to the FAB criteria, there were 1,5,85,17,10,7,65,12 cases in M0, Ml 5,M2,M4, M4EO, M5a, M5b, M6 respectively. The M2 and M4/M5 subtypes make up about 42.1% and 49.0% respectively.2. HAML had higher incidence of splenomegaly,lymphadenectasis,hypokalemia, consumption coagulopathy,infection and pulmonary leukostasis (P<0.05).3. HAML patients with M4/M5 FAB subtypes had a lower complete response (CR) rate compared with the patients of non-M4/M5 HAML.Whereas,the incidence of complication,disease-free survival(DFS),overall survival(OS) between two groups had no difference.4. Leukocytoreduction was applicated in 63 HAML patients, including hydroxyurea(Hu) in 33 patients, cytarabine(Ara-C)±Hu in 14 patients and leukapheresis+Ara-C/Hu in 16 patients. Leukapheresis had no impact on prognosis of HAML patients.5. Early death(ED) occurred in 4 patients (6.1%) in patients with HAML. Consumption coagulopathy (P=0.001),pulmonary leukostasis (P=0.001), and CNS leukostasis (P=0.001) were significantly associated with ED. Induction chemotherapy was completed in 62 HAML patients, leading to CR in 38(66.7%) cases, PR in 6 cases and NR in 13 cases. CR was related to age and FAB subtypes (P<0.05). In HAML patients,3-year DFS,3-year OS were 45.7% and 32.5% respectively. DFS was associated with age and karyotype(P=0.002). OS was associated with CR(P=0.002).6. CR rate,3-year DFS,3-year OS in NHAML patients were 90.5%,44.7%,45.6% respectively. Hyperleukocytosis significantly reduced the CR rate and the 3-year OS (P<0.01) but did not influence the 3-year DFS (P>0.4).7. Cytogenetic analysis was performed in 57 HAML patients, including 4 patients with favourable karyotype,45 patients with intermediate karyotype and 8 patinets with unfavourable karyotype. Cytogenetic analysis was performed in 182 NHAML patients,including 35 patients with favourable karyotype,120 patients with intermediate karyotype,27 patients with unfavourable karyotype. CR rate,3-year DFS,3-year OS in HAML patients with intermediate karyotype,were 61.4%,41.0%, 31.5% respectively.CR rate,3-year DFS,3-year OS in NHAML patients with intermediate karyotype,were 89.9%,44.6%,44.8% respectively.The HAML patients with intermediate karyotypes had significant difference in CR rate and the 3-year OS (P<0.05) with the NHAML patients with intermediate karyotype.There was no significant difference in DFS (P>0.6).Conclusion1. HAML had a higher incidence of splenomegaly,lymphadenectasis,hypokalemia, consumption coagulopathy,infection and pulmonary leukostasis (P<0.05). Most of HAML patients were M4/M5 FAB subtypes.2. CR rate of HAML patients was associated with age and FAB subtype. DFS was associated with age and karyotype. OS was associated with CR.3. HAML patients had special characteristics. CR rate and the 3-year OS were different between HAML patients and NHAML patients who had the same DFS.4. WBC≥100×109/L was especially important for evaluating the prognosis of the patients with intermediate karyotypes.
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