Annals of Hematology

, Volume 98, Issue 3, pp 541–559 | Cite as

The leukemia strikes back: a review of pathogenesis and treatment of secondary AML

  • Edna Cheung
  • Anthony J. Perissinotti
  • Dale L. Bixby
  • Patrick W. Burke
  • Kristen M. Pettit
  • Lydia L. Benitez
  • Julia Brown
  • Gianni B. Scappaticci
  • Bernard L. MariniEmail author
Review Article


Secondary AML is associated with a disproportionately poor prognosis, consistently shown to exhibit inferior response rates, event-free survival, and overall survival in comparison with de novo AML. Secondary AML may arise from the evolution of an antecedent hematologic disorder, or it may arise as a complication of prior cytotoxic chemotherapy or radiation therapy in the case of therapy-related AML. Because of the high frequency of poor-risk cytogenetics and high-risk molecular features, such as alterations in TP53, leukemic clones are often inherently chemoresistant. Standard of care induction had long remained conventional 7 + 3 until its reformulation as CPX-351, recently FDA approved specifically for secondary AML. However, recent data also suggests relatively favorable outcomes with regimens based on high-dose cytarabine or hypomethylating agents. With several investigational agents being studied, the therapeutic landscape becomes even more complex, and the treatment approach involves patient-specific, disease-specific, and therapy-specific considerations.


Secondary AML Therapy-related AML AML with myelodysplasia-related changes Liposomal daunorubicin and cytarabine FLAG Hypomethylating agents 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Edna Cheung
    • 1
  • Anthony J. Perissinotti
    • 1
  • Dale L. Bixby
    • 2
  • Patrick W. Burke
    • 2
  • Kristen M. Pettit
    • 2
  • Lydia L. Benitez
    • 1
  • Julia Brown
    • 1
  • Gianni B. Scappaticci
    • 1
  • Bernard L. Marini
    • 1
    Email author
  1. 1.Department of Pharmacy Services and Clinical SciencesMichigan Medicine and University of Michigan College of PharmacyAnn ArborUSA
  2. 2.Department of Internal Medicine, Division of Hematology/Oncology, Adult BMT and Leukemia ProgramsMichigan Medicine and University of Michigan Medical SchoolAnn ArborUSA

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