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Cytogenetic and molecular diagnostic characterization combined to postconsolidation minimal residual disease assessment by flow cytometry improves risk stratification in adult acute myeloid leukemia.
- Source :
-
Blood [Blood] 2010 Sep 30; Vol. 116 (13), pp. 2295-303. Date of Electronic Publication: 2010 Jun 14. - Publication Year :
- 2010
-
Abstract
- A total of 143 adult acute myeloid leukemia (AML) patients with available karyotype (K) and FLT3 gene mutational status were assessed for minimal residual disease (MRD) by flow cytometry. Twenty-two (16%) patients had favorable, 115 (80%) intermediate, and 6 (4%) poor risk K; 19 of 129 (15%) carried FLT3-ITD mutation. Considering postconsolidation MRD status, patients with good/intermediate-risk K who were MRD(-) had 4-year relapse-free survival (RFS) of 70% and 63%, and overall survival (OS) of 84% and 67%, respectively. Patients with good- and intermediate-risk K who were MRD(+) had 4-year RFS of 15% and 17%, and OS of 38% and 23%, respectively (P < .001 for all comparisons). FLT3 wild-type patients achieving an MRD(-) status, had a better outcome than those who remained MRD(+) (4-year RFS, 54% vs 17% P < .001; OS, 60% vs 23%, P = .002). Such an approach redefined cytogenetic/genetic categories in 2 groups: (1) low-risk, including good/intermediate K-MRD(-) with 4-year RFS and OS of 58% and 73%, respectively; and (2) high risk, including poor-risk K, FLT3-ITD mutated cases, good/intermediate K-MRD(+) categories, with RFS and OS of 22% and 17%, respectively (P < .001 for all comparisons). In AML, the integrated evaluation of baseline prognosticators and MRD improves risk-assessment and optimizes postremission therapy.
- Subjects :
- Adolescent
Adult
Aged
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Cytogenetic Analysis
Female
Flow Cytometry
Humans
Leukemia, Myeloid, Acute drug therapy
Male
Middle Aged
Mutation
Neoplasm, Residual
Nuclear Proteins genetics
Nucleophosmin
Prognosis
Risk Factors
Young Adult
fms-Like Tyrosine Kinase 3 genetics
Leukemia, Myeloid, Acute genetics
Subjects
Details
- Language :
- English
- ISSN :
- 1528-0020
- Volume :
- 116
- Issue :
- 13
- Database :
- MEDLINE
- Journal :
- Blood
- Publication Type :
- Academic Journal
- Accession number :
- 20548095
- Full Text :
- https://doi.org/10.1182/blood-2009-12-258178