Impact of Pretransplantation Minimal Residual Disease, As Detected by Multiparametric Flow Cytometry, on Outcome of Myeloablative Hematopoietic Cell Transplantation for Acute Myeloid Leukemia
Autor: | Ted Gooley, Emily Lansverk, Elihu H. Estey, Ajay K. Gopal, Mohamed L. Sorror, John M. Pagel, Min Fang, Brent L. Wood, Frederick R. Appelbaum, Jason W. Chien, Filippo Milano, Alexander I. Salter, Roland B. Walter |
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Rok vydání: | 2011 |
Předmět: |
Adult
Male Oncology Cancer Research medicine.medical_specialty Pathology Neoplasm Residual Transplantation Conditioning Myeloid Adolescent medicine.medical_treatment Population Hematopoietic stem cell transplantation Young Adult hemic and lymphatic diseases Internal medicine Original Reports Humans Transplantation Homologous Medicine Child education Aged Retrospective Studies education.field_of_study business.industry Remission Induction Hematopoietic Stem Cell Transplantation Infant Myeloid leukemia Middle Aged Flow Cytometry Prognosis medicine.disease Minimal residual disease Survival Rate Transplantation Leukemia Myeloid Acute Leukemia medicine.anatomical_structure Child Preschool Female Bone marrow business |
Zdroj: | Journal of Clinical Oncology. 29:1190-1197 |
ISSN: | 1527-7755 0732-183X |
Popis: | Purpose Allogeneic hematopoietic cell transplantation (HCT) benefits many patients with acute myeloid leukemia (AML) in first remission. Hitherto, little attention has been given to the prognostic impact of pretransplantation minimal residual disease (MRD). Patients and Methods We retrospectively studied 99 consecutive patients receiving myeloablative HCT for AML in first morphologic remission. Ten-color multiparametric flow cytometry (MFC) was performed on bone marrow aspirates before HCT. MRD was identified as a cell population showing deviation from normal antigen expression patterns compared with normal or regenerating marrow. Any level of residual disease was considered MRD positive. Results Before HCT, 88 patients met morphologic criteria for complete remission (CR), whereas 11 had CR with incomplete blood count recovery (CRi). Twenty-four had MRD before HCT as determined by MFC. Two-year estimates of overall survival were 30.2% (range, 13.1% to 49.3%) and 76.6% (range, 64.4% to 85.1%) for MRD-positive and MRD-negative patients; 2-year estimates of relapse were 64.9% (range, 42.0% to 80.6%) and 17.6% (range, 9.5% to 27.9%). After adjustment for all or a subset of cytogenetic risk, secondary disease, incomplete blood count recovery, and abnormal karyotype pre-HCT, MRD-positive HCT was associated with increased overall mortality (hazard ratio [HR], 4.05; 95% CI, 1.90 to 8.62; P < .001) and relapse (HR, 8.49; 95% CI, 3.67 to 19.65; P < .001) relative to MRD-negative HCT. Conclusion These data suggest that pre-HCT MRD is associated with increased risk of relapse and death after myeloablative HCT for AML in first morphologic CR, even after controlling for other risk factors. |
Databáze: | OpenAIRE |
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