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Molecular Detection of Minimal Residual Disease before Allogeneic Stem Cell Transplantation Predicts a High Incidence of Early Relapse in Adult Patients with NPM1 Positive Acute Myeloid Leukemia.
- Source :
- Cancers; Oct2019, Vol. 11 Issue 10, p1455, 1p
- Publication Year :
- 2019
-
Abstract
- We analyzed the impact of alloHSCT in a single center cohort of 89 newly diagnosed NPM1<superscript>mut</superscript> AML patients, consecutively treated according to the Northern Italy Leukemia Group protocol 02/06 [NCT00495287]. After two consolidation cycles, the detection of measurable residual disease (MRD) by RQ-PCR was strongly associated with an inferior three-year overall survival (OS, 45% versus 84%, p = 0.001) and disease-free survival (DFS, 44% versus 76%, p = 0.006). In MRD-negative patients, post-remissional consolidation with alloHSCT did not provide a significant additional benefit over a conventional chemotherapy in terms of overall survival [OS, 89% (95% CI 71–100%) versus 81% (95% CI 64–100%), p = 0.59] and disease-free survival [DFS, 80% (95% CI 59–100%) versus 75% (95% CI 56–99%), p = 0.87]. On the contrary, in patients with persistent MRD positivity, the three-year OS and DFS were improved in patients receiving an alloHSCT compared to those allocated to conventional chemotherapy (OS, 52% versus 31%, p = 0.45 and DFS, 50% versus 17%, p = 0.31, respectively). However, in this group of patients, the benefit of alloHSCT was still hampered by a high incidence of leukemia relapse during the first year after transplantation (43%, 95% CI 25–60%). Consolidative alloHSCT improves outcomes compared to standard chemotherapy in patients with persistent NPM1<superscript>mut</superscript> MRD positivity, but in these high-risk patients, the significant incidence of leukemia relapse must be tackled by post-transplant preemptive treatments. [ABSTRACT FROM AUTHOR]
- Subjects :
- ACUTE myeloid leukemia diagnosis
DISEASE relapse
CARCINOGENESIS
CONFIDENCE intervals
HEMATOPOIETIC stem cell transplantation
MOLECULAR diagnosis
GENETIC mutation
POLYMERASE chain reaction
SURVIVAL analysis (Biometry)
ACUTE myeloid leukemia
TREATMENT effectiveness
NUCLEAR proteins
DESCRIPTIVE statistics
EVALUATION
ADULTS
Subjects
Details
- Language :
- English
- ISSN :
- 20726694
- Volume :
- 11
- Issue :
- 10
- Database :
- Complementary Index
- Journal :
- Cancers
- Publication Type :
- Academic Journal
- Accession number :
- 139256299
- Full Text :
- https://doi.org/10.3390/cancers11101455