Prognostic Implications of CD14 Positivity in Acute Myeloid Leukemia Arising from Myelodysplastic Syndrome

Secondary acute myeloid leukemia (s-AML) arising from myelodysplastic syndrome (MDS) shows different clinical features from de novo AML. We assessed the prognostic significance of immunophenotypic markers in patients with s-AML arising from MDS. Sixty-five adults diagnosed with AML arising from MDS between 1996 and 2010 were retrospectively analyzed. Immunophenotyping was performed for markers including CD3, CD7, CD10, CD13, CD14, CD19, CD33, CD34, CD41, CD45, CD56, CD65, CD117, HLA-DR, and TdT. Of these immunophenotypic markers, only CD14 positivity was significantly associated with lower complete remission rate (P = 0.034) and significantly shorter overall survival (OS, P < 0.001) and event-free survival (EFS, P < 0.001) on univariate analysis. On multivariate analysis, these differences remained significant in terms of OS [hazard ratio (HR) 4.49; P < 0.001] and EFS (HR 4.06; P < 0.001). Other significant prognostic variables included age ≥60 years [shorter OS (P = 0.003) and EFS (P = 0.020)], higher WBC count (>60,000/μL) [shorter OS (P < 0.001) and EFS (P = 0.001)], and poor cytogenetic risk group [shorter OS (P = 0.005)]. CD14 expression on leukemic blasts is an independent prognostic factor for survival outcomes in patients with AML arising from MDS.