High Prognostic Impact of Flow Cytometric Minimal Residual Disease Detection in Acute Myeloid Leukemia: Data From the HOVON/SAKK AML 42A Study
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Published:2013-11-01
Issue:31
Volume:31
Page:3889-3897
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ISSN:0732-183X
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Container-title:Journal of Clinical Oncology
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language:en
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Short-container-title:JCO
Author:
Terwijn Monique1, van Putten Wim L.J.1, Kelder Angèle1, van der Velden Vincent H.J.1, Brooimans Rik A.1, Pabst Thomas1, Maertens Johan1, Boeckx Nancy1, de Greef Georgine E.1, Valk Peter J.M.1, Preijers Frank W.M.B.1, Huijgens Peter C.1, Dräger Angelika M.1, Schanz Urs1, Jongen-Lavrecic Mojca1, Biemond Bart J.1, Passweg Jakob R.1, van Gelder Michel1, Wijermans Pierre1, Graux Carlos1, Bargetzi Mario1, Legdeur Marie-Cecile1, Kuball Jurgen1, de Weerdt Okke1, Chalandon Yves1, Hess Urs1, Verdonck Leo F.1, Gratama Jan W.1, Oussoren Yvonne J.M.1, Scholten Willemijn J.1, Slomp Jennita1, Snel Alexander N.1, Vekemans Marie-Christiane1, Löwenberg Bob1, Ossenkoppele Gert J.1, Schuurhuis Gerrit J.1
Affiliation:
1. Monique Terwijn, Angèle Kelder, Peter C. Huijgens, Angelika M. Dräger, Yvonne J.M. Oussoren, Willemijn J. Scholten, Alexander N. Snel, Gert J. Ossenkoppele, and Gerrit J. Schuurhuis, VU University Medical Centre; Bart J. Biemond, Academic Medical Centre, Amsterdam; Wim L.J. van Putten, Vincent H.J. van der Velden, Georgine E. de Greef, Peter J.M. Valk, Mojca Jongen-Lavrecic, and Bob Löwenberg, Erasmus University Medical Centre; Rik A. Brooimans, Jan W. Gratama, Erasmus University Medical Centre/Daniel...
Abstract
Purpose Half the patients with acute myeloid leukemia (AML) who achieve complete remission (CR), ultimately relapse. Residual treatment-surviving leukemia is considered responsible for the outgrowth of AML. In many retrospective studies, detection of minimal residual disease (MRD) has been shown to enable identification of these poor-outcome patients by showing its independent prognostic impact. Most studies focus on molecular markers or analyze data in retrospect. This study establishes the value of immunophenotypically assessed MRD in the context of a multicenter clinical trial in adult AML with sample collection and analysis performed in a few specialized centers. Patients and Methods In adults (younger than age 60 years) with AML enrolled onto the Dutch-Belgian Hemato-Oncology Cooperative Group/Swiss Group for Clinical Cancer Research Acute Myeloid Leukemia 42A study, MRD was evaluated in bone marrow samples in CR (164 after induction cycle 1, 183 after cycle 2, 124 after consolidation therapy). Results After all courses of therapy, low MRD values distinguished patients with relatively favorable outcome from those with high relapse rate and adverse relapse-free and overall survival. In the whole patient group and in the subgroup with intermediate-risk cytogenetics, MRD was an independent prognostic factor. Multivariate analysis after cycle 2, when decisions about consolidation treatment have to be made, confirmed that high MRD values (> 0.1% of WBC) were associated with a higher risk of relapse after adjustment for consolidation treatment time-dependent covariate risk score and early or later CR. Conclusion In future treatment studies, risk stratification should be based not only on risk estimation assessed at diagnosis but also on MRD as a therapy-dependent prognostic factor.
Publisher
American Society of Clinical Oncology (ASCO)
Subject
Cancer Research,Oncology
Cited by
359 articles.
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