| Objective:Leukemia cutis(LC)is the characteristic manifestation of skin infiltration by immature myeloid cells.It can be mainly found in acute myeloid leukemia(AML).The aim of our study was to analyze the clinical features of AML patients with LC.We also compared the clinical characteristics in AML patients with and without LC,and examined the prognostic impact of LC in AML.Methods:Between 2011 and 2017,LC in adult AML patients,not including acute promyelocytic leukemia,were retrospectively reviewed and we also compared the characteristic differences in AML patients with and without LC.The prognostic impact of LC for AML patients was studied in survival analysis.Results:(1)Among 21 LC patients in AML,71%cases occurred at the first visit,relapse or progression of primary AML,19%in myelodysplastic syndromes(MDS)progressed to AML,5%in chronic myeloid leukemia blast crisis phase and the remaining 5%in therapy-related AML.LC mainly affected middle-aged male person.M5 FAB category accounted for 57%.The eruption appeared as single or multiple,clustered or scattered papules,nodules and/or plaques,localizing to the trunk and extremities.The biopsy of skin lesions in 12 biopsy-proven LC showed diffuse or nodular tumor cells within the dermis and subcutaneous fat layer.Among 21 patients,5 of them also had leukemic infiltration of central nervous system,bone,lymph gland,liver or kidney.41.2%patients with LC were responsive to conventional induction chemotherapy.76.9%AML patients died after the diagnosis of LC within one year.(2)Compared with AML patients without LC,patients with clinically diagnosed LC had higher lactate dehydrogenase(LDH)(708U/L vs 3 72U/L),more M5 FAB category(66.7%vs 36.0%),less M2 FAB category(22.2%vs 43.0%)and more male(76.2%vs 56.0%),but these differences were not significant.Compared with AML patients without LC,patients with biopsy-proven cases had more M5 FAB category(58.3%vs 22.9%),less M2 FAB category(25.0%vs 58.3%),but the differences were not significant.Patients with or without clinically diagnosed or biopsy-proven LC didn't differ among factors like age,white blood cell,hemoglobin,platelet,fibrinogen,bone marrow blasts,cytogenetic risk group,the history of MDS,therapy-related AML and leukemic infiltration of other organs.(3)In the prognostic analysis of biopsy-proven LC on AML,patients with LC had shorter overall survival in univariate analysis(P=0.080).And factors associated with shorter overall survival also included age above 60(P<0.001),white blood cell counts above 100 at initial diagnosis(P=0.058),M5 FAB category(P=0.031),central nervous system leukemia(P=0.079),the history of MDS(P=0.020),therapy-related AML(P=0.091),without transplantation(P=0.032),unfavorable risk classification(P=0.007)and not remission after induction chemotherapy(P<0.001).And in multivariable model,LC had shorter overall survival with an independent significance by adjusting for known prognostic factors(P=0.002).And factors like age(P=0.009),neutrophil-to-lymphocyte ratio at initial diagnosis(P=0.018),fibrinogen(P=0.026),the percentage of blasts in marrow(P=0.043),transplantation(P=0.040),risk classification and the response after the first induction chemotherapy were also independently prognostic.Conclusions:LC mostly appeared as initial symptom of primary AML or developed during the progression or relapse of disease.The majority of patients were AML M5 subtype.It mainly affected middle-aged man.Clinical lesions in LC were single or multiple,clustered or scattered papules,nodules and/or plaques,localizing to the trunk and extremities.The biopsy of skin lesions showed diffuse or nodular tumor cells within the dermis and subcutaneous fat layer.Most patients with LC were unresponsive to conventional induction chemotherapy and appeared as primary drug-resistance.Most patients died after the diagnosis of AML within one year.AML patients with LC had shorter overall survival compared with patients without LC.And the presence of LC was an independent risk factor on the prognosis of AML. |
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