Measurable Residual Disease at Induction Redefines Partial Response in Acute Myeloid Leukemia and Stratifies Outcomes in Patients at Standard Risk Without NPM1 Mutations

Autor: Paul Virgo, Laura Upton, Nigel H. Russell, Steve Couzens, Richard Dillon, Robert Kerrin Hills, Asim Khwaja, Amanda F. Gilkes, Gail Jones, Davied Grimwade, Naeem Khan, Alan Kenneth Burnett, Sylvie D. Freeman, Ove Juul Nielsen, Ian Thomas, P Cahalin, James D. Cavenagh
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Adult
Male
Oncology
Cancer Research
medicine.medical_specialty
NPM1
Neoplasm
Residual
Myeloid
Adolescent
Daunorubicin
medicine.medical_treatment
Hematopoietic stem cell transplantation
03 medical and health sciences
0302 clinical medicine
Risk Factors
Internal medicine
hemic and lymphatic diseases
Antineoplastic Combined Chemotherapy Protocols
Humans
Medicine
Prospective Studies
Aged
business.industry
Cytarabine
Hematopoietic Stem Cell Transplantation
Nuclear Proteins
Myeloid leukemia
Induction Chemotherapy
Middle Aged
Flow Cytometry
medicine.disease
Minimal residual disease
Survival Rate
body regions
Leukemia
Myeloid
Acute
Leukemia
Treatment Outcome
medicine.anatomical_structure
030220 oncology & carcinogenesis
Mutation
Absolute neutrophil count
Female
business
Nucleophosmin
030215 immunology
medicine.drug
Zdroj: Freeman, S D, Hills, R K, Virgo, P, Khan, N, Couzens, S, Dillon, R, Gilkes, A, Upton, L, Nielsen, O J, Cavenagh, J D, Jones, G, Khwaja, A, Cahalin, P, Thomas, I, Grimwade, D, Burnett, A K & Russell, N H 2018, ' Measurable Residual Disease at Induction Redefines Partial Response in Acute Myeloid Leukemia and Stratifies Outcomes in Patients at Standard Risk Without NPM1 Mutations ', Journal of clinical oncology : official journal of the American Society of Clinical Oncology, vol. 36, no. 15, pp. 1486-1497 . https://doi.org/10.1200/JCO.2017.76.3425
ISSN: 0732-183X
Popis: Terms of Use.\udJournal of Clinical Oncology\udLog In\udassignment_turned_inSubmit\udmail_outlineE-Alerts\udadd_shopping_cartSubscribe\ud\udOpenAthens/Shibboleth »\udAdvanced Search\ud\ud Newest Articles\ud Issues\ud Special Content\ud Authors\ud Subscribers\ud About\ud ASCO Publications\ud Career Center\ud COVID-19\ud\ud\ud\ud\ud\ud\ud\ud\ud\ud\ud\ud\ud\ud Journal of Clinical Oncology > List of Issues > Volume 36, Issue 15 > \ud\udORIGINAL REPORTS Hematologic Malignancy\udArticle Tools\udOPTIONS & TOOLS\udExport Citation \udTrack Citation \udAdd To Favorites \udPurchase\ud\ud Rights & Permissions \ud\udArticle has an altmetric score of 27\udCOMPANION ARTICLES\ud\ud Minimal Residual Disease Testing After Induction Chemotherapy for Acute Myeloid Leukemia: Moving Beyond Prognostication?. April 06, 2018\ud\udARTICLE CITATION\ud\udDOI: 10.1200/JCO.2017.76.3425 Journal of Clinical Oncology - published online before print March 30, 2018\ud\udPMID: 29601212\udMeasurable Residual Disease at Induction Redefines Partial Response in Acute Myeloid Leukemia and Stratifies Outcomes in Patients at Standard Risk Without NPM1 Mutations\udSylvie D. Freeman, Robert K. Hills, Paul Virgo, Naeem Khan, Steve Couzens, Richard Dillon, ...\udShow More\ud\udS.D.F. and R.K. H. contributed equally to this work.\ud\ud Abstract\ud Full Text\ud PDF\ud Figures and Tables\ud Supplements\ud\udPurpose\ud\udWe investigated the effect on outcome of measurable or minimal residual disease (MRD) status after each induction course to evaluate the extent of its predictive value for acute myeloid leukemia (AML) risk groups, including NPM1 wild-type (wt) standard risk, when incorporated with other induction response criteria.\udMethods\ud\udAs part of the NCRI AML17 trial, 2,450 younger adult patients with AML or high-risk myelodysplastic syndrome had prospective multiparameter flow cytometric MRD (MFC-MRD) assessment. After course 1 (C1), responses were categorized as resistant disease (RD), partial remission (PR), and complete remission (CR) or complete remission with absolute neutrophil count < 1,000/µL or thrombocytopenia < 100,000/μL (CRi) by clinicians, with CR/CRi subdivided by MFC-MRD assay into MRD+ and MRD−. Patients without high-risk factors, including Flt3 internal tandem duplication wt/−NPM1-wt subgroup, received a second daunorubicin/cytosine arabinoside induction; course 2 (C2) was intensified for patients with high-risk factors.\udResults\ud\udSurvival outcomes from PR and MRD+ responses after C1 were similar, particularly for good- to standard-risk subgroups (5-year overall survival [OS], 27% RD v 46% PR v 51% MRD+ v 70% MRD−; P < .001). Adjusted analyses confirmed significant OS differences between C1 RD versus PR/MRD+ but not PR versus MRD+. CRi after C1 reduced OS in MRD+ (19% CRi v 45% CR; P = .001) patients, with a smaller effect after C2. The prognostic effect of C2 MFC-MRD status (relapse: hazard ratio [HR], 1.88 [95% CI, 1.50 to 2.36], P < .001; survival: HR, 1.77 [95% CI, 1.41 to 2.22], P < .001) remained significant when adjusting for C1 response. MRD positivity appeared less discriminatory in poor-risk patients by stratified analyses. For the NPM1-wt standard-risk subgroup, C2 MRD+ was significantly associated with poorer outcomes (OS, 33% v 63% MRD−, P = .003; relapse incidence, 89% when MRD+ ≥ 0.1%); transplant benefit was more apparent in patients with MRD+ (HR, 0.72; 95% CI, 0.31 to 1.69) than those with MRD− (HR, 1.68 [95% CI, 0.75 to 3.85]; P = .16 for interaction).\udConclusion\ud\udMFC-MRD can improve outcome stratification by extending the definition of partial response after first induction and may help predict NPM1-wt standard-risk patients with poor outcome who benefit from transplant in the first CR.
Databáze: OpenAIRE
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