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ELN2017 risk stratification improves outcome prediction when applied to the prospective GIMEMA AML1310 protocol
- Source :
- Blood advances. 6(8)
- Publication Year :
- 2021
-
Abstract
- The 2017 version of the European LeukemiaNet (ELN) recommendations, by integrating cytogenetics and mutational status of specific genes, divides patients with acute myeloid leukemia into 3 prognostically distinct risk categories: favorable (ELN2017-FR), intermediate (ELN2017-IR), and adverse (ELN2017-AR). We performed a post hoc analysis of the GIMEMA (Gruppo Italiano Malattie EMatologiche dell’Adulto) AML1310 trial to investigate the applicability of the ELN2017 risk stratification to our study population. In this trial, after induction and consolidation, patients in complete remission were to receive an autologous stem cell transplant (auto-SCT) if categorized as favorable risk or an allogeneic stem cell transplant (allo-SCT) if adverse risk. Intermediate-risk patients were to receive auto-SCT or allo-SCT based on the postconsolidation levels of measurable residual disease as measured by using flow cytometry. Risk categorization was originally conducted according to the 2009 National Comprehensive Cancer Network recommendations. Among 500 patients, 445 (89%) were reclassified according to the ELN2017 criteria: ELN2017-FR, 186 (41.8%) of 455; ELN2017-IR, 179 (40.2%) of 445; and ELN2017-AR, 80 (18%) of 455. In 55 patients (11%), ELN2017 was not applicable. Two-year overall survival (OS) was 68.8%, 51.3%, 45.8%, and 42.8% for the ELN2017-FR, ELN2017-IR, ELN2017-not classifiable, and ELN2017-AR groups, respectively (P < .001). When comparing the 2 different transplant strategies in each ELN2017 risk category, a significant benefit of auto-SCT over allo-SCT was observed among ELN2017-FR patients (2-year OS of 83.3% vs 66.7%; P = .0421). The 2 transplant procedures performed almost equally in the ELN2017-IR group (2-year OS of 73.9% vs 70.8%; P = .5552). This post hoc analysis of the GIMEMA AML1310 trial confirms that the ELN2017 classification is able to accurately discriminate patients with different outcomes and who may benefit from different transplant strategies. This trial was registered as EudraCT number 2010-023809-36 and at www.clinicaltrials.gov as #NCT01452646.
- Subjects :
- medicine.medical_specialty
Humans
Neoplasm, Residual
Prognosis
Prospective Studies
Risk Assessment
Transplantation, Homologous
autologous stem cell transplantation
post hoc analysi
overall survival
Article
remission
male
allogeneic stem cell transplantation
MED/15 - MALATTIE DEL SANGUE
Internal medicine
medicine
Overall survival
Mutational status
human
outcome assessment
business.industry
cytogenetic
adult
flow cytometry
Complete remission
Myeloid leukemia
Hematology
prediction
Settore MED/15
major clinical study
female
Acute myeloid leukemia, gimema aml1310, outcome prediction, risk stratification
Risk stratification
survival analysi
minimal residual disease
treatment outcome
Population study
Risk categorization
business
Outcome prediction
intermediate risk patient
prospective study
Subjects
Details
- ISSN :
- 24739537
- Volume :
- 6
- Issue :
- 8
- Database :
- OpenAIRE
- Journal :
- Blood advances
- Accession number :
- edsair.doi.dedup.....8e3754aea28145e7ddf92fd21a7acdcc