| Abstrakt: |
Introduction: Minimal residual disease (MRD) is a prognostic factor for relapses and overall survival (OS) in AML patients. Nevertheless, the predictive value and optimal timing to assess MRD remain discussed. This study investigated the significance of MRD in real-world, single-center data retrospectively. Material and methods: In median time of observation 11,4 months (3,1-70,9) 92 patients with AML (excluding acute promyelocytic leukaemia), eligible for intensive chemotherapy with defined leukemia associated immunophenotypes (LAIPs) were included. OS and RFS (relapse free survival) were analysed with respect to MRD detected by multiparameter flow cytometry (FCM) after induction therapy (1 or 2 cycles if required), after consolidation (1-3 cycles) and before allogeneic hematopoietic stem cell transplantation (allo-HSCT). The threshold of <0,1% were used for MRD-. Results: Complete remission (CR) or CR with incomplete hematologic recovery (CRi) either after single or double induction was achieved in 77,1% (71/92) patients with 36,9% (34/92) MRD- and 40,2% (37/92) MRD+. Among 44 transplanted patients 34%(15/44) were MRD- and 63,6%(28/44) MRD+ before allo-HSCT. 18 patients died (14 due to progression of AML), 9 patients were not qualified for allo-HSCT (6 with favorable ELN risk). Patients MRD- in any measurement (21/71) have longer OS (HR 2.53; 95% CI: 1.24-5.16; p = 0,032) and RFS (HR 2,74; 95% CI: 1.35-5.53; p = 0.019) versus MRD+ at any timepoint. MRD- after induction, consolidation or before allo- HSCT did not have an impact on OS and RFS, however MRD- after induction showed a trend for longer survival. In univariate analyses, the factors affecting OS were: newly-diagnosed vs. secondary AML (HR 0.55; 95% CI: 0.30-0.99; p <0.046), intermediate ELN risk (HR 2.78; 95% CI: 1.05-7.22; p <0.035) and therapy-related AML (HR 4.21; 95% CI: 1.49-11.8; p = 0.006). FLT3-ITD mutation (HR 2.32; 95% CI: 1.15-4.7; p = 0.019) and ELN adverse risk (HR 4.34; 95% CI: 1.26-14.94; p = 0.02) had an impact on PFS. Conclusion: Permanent negativization of MRD by FCM prolongs OS and RFS in AML patients. [ABSTRACT FROM AUTHOR] |
