Persistence of minimal residual disease assessed by multiparameter flow cytometry is highly prognostic in younger patients with acute myeloid leukemia. Issue 3 (22nd September 2016)

• Record Type: Journal Article
• Authors: Ravandi, Farhad; Jorgensen, Jeffrey; Borthakur, Gautam; Jabbour, Elias; Kadia, Tapan; Pierce, Sherry; Brandt, Mark; Wang, Sa; Konoplev, Sergej; Wang, Xuemei; Huang, Xuelin; Daver, Naval; DiNardo, Courtney; Andreeff, Michael; Konopleva, Marina; Estrov, Zeev; Garcia‐Manero, Guillermo; Cortes, Jorge; Kantarjian, Hagop
• Is Part Of: Cancer. Volume 123:Issue 3(2017)
• Page Start: 426
• Page End: 435
• Publication Date: 2016-09-22
• Subjects: acute myeloid leukemia -- minimal residual disease -- prognostic -- relapse‐free survival -- survival; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.30361
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : BACKGROUND: Predicting outcomes for patients with acute myeloid leukemia (AML) on the basis of pretreatment predictors has been the cornerstone of management. Posttreatment prognostic factors are increasingly being evaluated. METHODS: Among 280 younger patients who were treated with intermediate‐dose cytarabine (total ≥ 5 g/m 2 ) and idarubicin‐based induction chemotherapy and achieved remission, 186 were assessed for minimal residual disease (MRD) with an 8‐color multiparameter flow cytometry panel performed on bone marrow specimens with a sensitivity of 0.1% or higher. RESULTS: One hundred sixty‐six patients had samples available 1 to 2 months after induction at the time of complete remission (CR), and 79% became negative for MRD, with an MRD‐negative status associated with an improvement in relapse‐free survival (RFS; P = .0002) and overall survival (OS; P = .0002). One hundred sixteen were evaluated for their MRD status during consolidation, and 86% were negative, with an MRD‐negative status associated with a significant improvement in RFS ( P < .0001) and OS ( P < .0001). Sixty‐nine patients were evaluated for their MRD status after completion of all therapy, and 84% were negative, with an MRD‐negative status associated with an improvement in RFS ( P < .0001) and OS ( P < .0001). In a multivariate analysis including age, cytogenetics, response (CR vs CR with incomplete platelet recovery/incomplete blood count recovery), and MRD, achieving an MRD‐negative status was the most important independent predictor of RFS and OS at response ( P = .008 and P = .0008, respectively), during consolidation ( P < .0001 for both), and at the completion of therapy ( P < .0001 and P = .002, respectively). CONCLUSIONS: Achieving an MRD‐negative status according to multiparameter flow cytometry is associated with a highly significant improvement in the outcomes of younger patients with AML receiving cytosine arabinoside plus idarubicin‐based induction and consolidation regimens. Cancer 2017;123:426–435. © 2016 American Cancer Society . Abstract : Minimal residual disease assessment by multiparameter flow cytometry after induction and consolidation has significant prognostic value for patients with acute myeloid leukemia. According to a multivariate analysis, persistent minimal residual disease is the most important predictor of relapse‐free and overall survival.