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Original Investigation
April 10, 2019

Association of Leukemia Cutis With Survival in Acute Myeloid Leukemia

Author Affiliations
  • 1Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
  • 2Division of Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
  • 3Division of Dermatology, Washington University School of Medicine in St Louis, St Louis, Missouri
JAMA Dermatol. Published online April 10, 2019. doi:10.1001/jamadermatol.2019.0052
Key Points

Question  What is the association of leukemia cutis with a patient’s acute myeloid leukemia course?

Findings  In this matched-cohort study of 1683 patients with acute myeloid leukemia, the presentation of leukemia cutis was associated with significantly decreased overall and leukemia-specific survival.

Meaning  The study suggests that leukemia cutis is associated with a poor prognosis for patients with systemic acute myeloid leukemia and that these patients may require more aggressive treatment and intensive monitoring throughout their clinical course.

Abstract

Importance  Leukemia cutis (LC) is an important yet understudied extramedullary manifestation of leukemia. Previous reports have suggested poor prognosis for patients with LC, but these reports have largely consisted of descriptive studies with a limited number of patients.

Objectives  To identify patient factors associated with LC and characterize the association of LC with the course of acute myeloid leukemia (AML).

Design, Setting, and Participants  This retrospective, matched-cohort study included 1683 patients with AML diagnosed from January 1, 2005, to April 1, 2017, with and without biopsy-proven LC seen at a single-center, tertiary care hospital in St Louis, Missouri. To specifically evaluate differences in survival, propensity scoring was used to match patients with AML with LC to patients with AML without LC off the logit of propensity score based on age, race/ethnicity, sex, and leukemia type. Kaplan-Meier methods were used to compare cumulative probability survival. Matched survival analysis was performed with extended Cox regression to determine factors associated with leukemia-specific and overall survival.

Main Outcomes and Measures  Leukemia-specific survival and overall survival.

Results  A total of 1683 patients were reviewed, including 78 patients with biopsy-proven LC of the AML type and 1605 patients with AML without LC. A total of 62 of the patients with AML and LC (mean [SD] age, 58.2 [11.7] years; 33 [53.2%] male) were matched in a 1:3 ratio to 186 patients with AML without LC (mean [SD] age, 58.2 [13.5] years; 103 [55.4%] male). The 5-year survival among the 62 patients with AML with LC was 8.6%, shorter than the 28.3% among the 186 matched patients with AML without LC. Matched survival analysis revealed that patients with AML and LC compared with those without LC had hazard ratios of 2.06 (95% CI, 1.26-3.38; P = .004) for leukemia-specific death and of 1.66 (95% CI, 1.06-2.60; P = .03) for all-cause death. In addition, matched patients with LC had greater odds of extramedullary organ burden (odds ratio, 3.48; 95% CI, 1.72-7.05; P < .001).

Conclusions and Relevance  The results suggest that the presentation of LC in patients with AML is associated with decreased overall survival and leukemia-specific survival. Patients with AML presenting with LC may require more intensive treatment and monitoring of their leukemic disease.

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