Purpose:Despite the identification of several baseline prognostic indicators, the outcome of patients with acute myeloid leukemia (AML) is generally heterogeneous. The effects of autologous (AuSCT) or allogeneic stem-cell transplantation (SCT) are still under evaluation. Minimal residual disease (MRD) states may be essential for assigning patients to therapy-dependent risk categories. Patients and Methods: By multiparametric flow cytometry, we assessed the levels of MRD in 142 patients with AML who achieved complete remission after intensive chemotherapy. Results: A level of 3.5 x 10(-4) residual leukemia cells (RLCs) after consolidation therapy was established to identify MRD-negative and MRD-positive cases, with 5-year relapse-free survival (RFS) rates of 60% and 16%, respectively (P <.0001) and overall survival (OS) rates of 62% and 23%, respectively (P=.0001). Of patients (n = 77) who underwent a transplantation procedure (56 AuSCT and 21 SCT procedures); 42 patients (55%) were MRD positive (28 patients who underwent AuSCT and 14 patients who underwent SCT) and 35 patients (45%) were MRD negative (28 patients who underwent AuSCT and seven who underwent SCT). MRD-negative patients had a favorable prognosis, with only eight (22%) of 35 patients experiencing relapse, whereas 29 (69%) of 42 MRD-positive patients experienced relapse (P <.0001). In this high-risk group of 42 patients, we observed that 23 (82%) of 28 of those who underwent AuSCT experienced relapse, whereas six (43%) of 14 who underwent SCT experienced relapse (P=.014). Patients who underwent SCT also had a higher likelihood of RFS (47% v 14%). Conclusion A threshold of 3.5 x 10(-4) RLCs postconsolidation is critical for predicting disease outcome. MRD-negative patients have a good outcome regardless of the type of transplant they receive. In the MRD-positive group, AuSCT does not improve prognosis and SCT represents the primary option.

Maurillo, L., Buccisano, F., DEL PRINCIPE, M.i., DEL POETA, G., Spagnoli, A., Panetta, P., et al. (2008). Toward optimization of postremission therapy for residual disease-positive patients with acute myeloid leukemia. JOURNAL OF CLINICAL ONCOLOGY, 26(30), 4944-4951 [10.1200/JCO.2007.15.9814].

Toward optimization of postremission therapy for residual disease-positive patients with acute myeloid leukemia

BUCCISANO, FRANCESCO;DEL PRINCIPE, MARIA ILARIA;DEL POETA, GIOVANNI;De Fabritiis, P;LO COCO, FRANCESCO;ARCESE, WILLIAM;AMADORI, SERGIO;VENDITTI, ADRIANO
2008-10-20

Abstract

Purpose:Despite the identification of several baseline prognostic indicators, the outcome of patients with acute myeloid leukemia (AML) is generally heterogeneous. The effects of autologous (AuSCT) or allogeneic stem-cell transplantation (SCT) are still under evaluation. Minimal residual disease (MRD) states may be essential for assigning patients to therapy-dependent risk categories. Patients and Methods: By multiparametric flow cytometry, we assessed the levels of MRD in 142 patients with AML who achieved complete remission after intensive chemotherapy. Results: A level of 3.5 x 10(-4) residual leukemia cells (RLCs) after consolidation therapy was established to identify MRD-negative and MRD-positive cases, with 5-year relapse-free survival (RFS) rates of 60% and 16%, respectively (P <.0001) and overall survival (OS) rates of 62% and 23%, respectively (P=.0001). Of patients (n = 77) who underwent a transplantation procedure (56 AuSCT and 21 SCT procedures); 42 patients (55%) were MRD positive (28 patients who underwent AuSCT and 14 patients who underwent SCT) and 35 patients (45%) were MRD negative (28 patients who underwent AuSCT and seven who underwent SCT). MRD-negative patients had a favorable prognosis, with only eight (22%) of 35 patients experiencing relapse, whereas 29 (69%) of 42 MRD-positive patients experienced relapse (P <.0001). In this high-risk group of 42 patients, we observed that 23 (82%) of 28 of those who underwent AuSCT experienced relapse, whereas six (43%) of 14 who underwent SCT experienced relapse (P=.014). Patients who underwent SCT also had a higher likelihood of RFS (47% v 14%). Conclusion A threshold of 3.5 x 10(-4) RLCs postconsolidation is critical for predicting disease outcome. MRD-negative patients have a good outcome regardless of the type of transplant they receive. In the MRD-positive group, AuSCT does not improve prognosis and SCT represents the primary option.
20-ott-2008
Pubblicato
Rilevanza internazionale
Articolo
Sì, ma tipo non specificato
Settore MED/15 - MALATTIE DEL SANGUE
English
anthracycline; cytarabine; etoposide; idarubicin; interleukin 2; mitoxantrone; antineoplastic agent; acute granulocytic leukemia; adult; aged; allogeneic stem cell transplantation; article; autologous stem cell transplantation; cancer combination chemotherapy; combination chemotherapy; controlled study; disease free survival; female; flow cytometry; high risk population; human; leukemia cell; leukemia remission; major clinical study; male; minimal residual disease; multiple cycle treatment; patient assessment; priority journal; prognosis; treatment outcome; allotransplantation; autotransplantation; methodology; middle aged; remission; stem cell transplantation; Adult; Aged; Anthracyclines; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Disease-Free Survival; Etoposide; Female; Humans; Leukemia, Myeloid, Acute; Male; Middle Aged; Neoplasm, Residual; Prognosis; Remission Induction; Stem Cell Transplantation; Transplantation, Autologous; Transplantation, Homologous; Treatment Outcome
Maurillo, L., Buccisano, F., DEL PRINCIPE, M.i., DEL POETA, G., Spagnoli, A., Panetta, P., et al. (2008). Toward optimization of postremission therapy for residual disease-positive patients with acute myeloid leukemia. JOURNAL OF CLINICAL ONCOLOGY, 26(30), 4944-4951 [10.1200/JCO.2007.15.9814].
Maurillo, L; Buccisano, F; DEL PRINCIPE, Mi; DEL POETA, G; Spagnoli, A; Panetta, P; Ammatuna, E; Neri, B; Ottaviani, L; Sarlo, C; Venditti, D; Quaresima, M; Cerretti, R; Rizzo, M; De Fabritiis, P; LO COCO, F; Arcese, W; Amadori, S; Venditti, A
Articolo su rivista
File in questo prodotto:
File Dimensione Formato  
MRD-JCO.pdf

accesso aperto

Licenza: Creative commons
Dimensione 208.55 kB
Formato Adobe PDF
208.55 kB Adobe PDF Visualizza/Apri

Questo articolo è pubblicato sotto una Licenza Licenza Creative Commons Creative Commons

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/43567
Citazioni
  • ???jsp.display-item.citation.pmc??? 52
  • Scopus 141
  • ???jsp.display-item.citation.isi??? 132
social impact