POST-INDUCTION MINIMAL RESIDUAL DISEASE ASSESSMENT BY BOTH MULTIPARAMETER FLOW CYTOMETRY AND RT-PCR PREDICTS OUTCOME IN ACUTE MYELOID LEUKEMIA
(Abstract release date: 05/19/16)
EHA Library. Bories C. 06/09/16; 132441; E892
Ms. Claire Bories
Contributions
Contributions
Abstract
Abstract: E892
Type: Eposter Presentation
Background
Minimal residual disease (MRD) assessment is essential during the follow-up of patients with acute myeloid leukemia (AML). Although it is not yet decisional, except in acute promyelocytic leukemia (APL), its evaluation by RT-PCR in AML has already shown a significant impact on survival in AML. Multiparameter Flow Cytometry (MFC) offers another option to monitor MRD, especially for acute leukemias that lack molecular markers. Furthermore, results can be obtained in a shorter timeframes, which could be of great use in the management of AML patients.
Aims
We aim to study MRD assessment by MFC and/or RT-PCR after induction therapy for AML and its impact on outcome.
Methods
Patients were retrospectively included from a database of 182 patients that had at least one MRD assessment for AML during their follow-up from 2005 to 2013. Patients that were diagnosed with AML, who received intensive chemotherapy, that obtained cytologic complete remission after one or two courses of induction-therapy, and that had their initial follow-up in our center were included. Exclusion criteria included APL patients.MRD was assessed by MFC based on leukemia-associated immunophenotype present at diagnosis, including cross-lineage markers and maturation asynchronies. RT-PCR-based MRD was evaluated by quantification of WT1 or NPM1 expression in either blood or bone marrow samples. MRD data were extracted between post-induction hematologic recovery and first consolidation for further analysis. Concordance between MFC and RT-PCR was evaluated for patients who had an MRD evaluation by both methods at the same time. Overall survival (OS) and relapse free survival (RFS) were estimated according to MRD status. OS and RFS were also evaluated after censoring data at the time of stem cell transplant.
Results
128 patients were eligible. Median age at diagnosis was 52 (range: 16 - 73). 36 patients had an initial leucocytosis superior to 50G/L. ELN prognostic groups were represented as follow: 36%, 27%, 22% and 15% of patients were classified in the favourable, intermediate-1, intermediate-2 and unfavourable groups respectively. De novo AML represented 118 out of the 128 patients. 60 patients underwent an allograft, 35 at first remission. 111 patients presented at least one MRD assessment, of whom 75 (68%) by MFC and 84 (76%) by RT-PCR (84 on WT1 and 26 on NPM1 expression). Concordance between both methods was relatively good since results were consistent with both methods for 35 of 44 samples. Interestingly, discordant samples were found in both ways – negative MCF-MRD with positive RT-PCR-MRD or positive MCF-MRD with negative RT-PCR-MRD.The median follow-up was 53 months. 3 years-OS was 61%. 65 patients (51%) relapsed during their follow-up. 3-years RFS was 42%. Patients with negative MRD (either by MCF or RT-PCR) had a better 3-years OS (68% versus 41%, p=0.002) and RFS (51% versus 27%, p=0.0045) than patients with positive MRD. Censoring data at the time of stem cell transplant did not impact the significativity of the results. For patients with only RT-PCR MRD assessment, the benefit of negative MRD was also significant on OS (p=0.0027) and RFS (p=0.0005). Considering only patients with MCF MRD assessment (75 patients), MRD had no significative impact on RFS (p=0.09) and OS (p=0.52).
Conclusion
As previously reported, we found that RT-PCR assessment of MRD is associated with OS and RFS in patients with AML. However only few studies have compared monitoring of MRD by both MCF and RT-PCR at post-induction time. We found a relatively good concordance between both methods. Moreover we showed that using MCF in addition to RT PCR for MRD assessment increased the number of patient that could be monitored at post induction time and was still correlated with outcome.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Flow cytometry, Minimal residual disease (MRD), RT-PCR
Type: Eposter Presentation
Background
Minimal residual disease (MRD) assessment is essential during the follow-up of patients with acute myeloid leukemia (AML). Although it is not yet decisional, except in acute promyelocytic leukemia (APL), its evaluation by RT-PCR in AML has already shown a significant impact on survival in AML. Multiparameter Flow Cytometry (MFC) offers another option to monitor MRD, especially for acute leukemias that lack molecular markers. Furthermore, results can be obtained in a shorter timeframes, which could be of great use in the management of AML patients.
Aims
We aim to study MRD assessment by MFC and/or RT-PCR after induction therapy for AML and its impact on outcome.
Methods
Patients were retrospectively included from a database of 182 patients that had at least one MRD assessment for AML during their follow-up from 2005 to 2013. Patients that were diagnosed with AML, who received intensive chemotherapy, that obtained cytologic complete remission after one or two courses of induction-therapy, and that had their initial follow-up in our center were included. Exclusion criteria included APL patients.MRD was assessed by MFC based on leukemia-associated immunophenotype present at diagnosis, including cross-lineage markers and maturation asynchronies. RT-PCR-based MRD was evaluated by quantification of WT1 or NPM1 expression in either blood or bone marrow samples. MRD data were extracted between post-induction hematologic recovery and first consolidation for further analysis. Concordance between MFC and RT-PCR was evaluated for patients who had an MRD evaluation by both methods at the same time. Overall survival (OS) and relapse free survival (RFS) were estimated according to MRD status. OS and RFS were also evaluated after censoring data at the time of stem cell transplant.
Results
128 patients were eligible. Median age at diagnosis was 52 (range: 16 - 73). 36 patients had an initial leucocytosis superior to 50G/L. ELN prognostic groups were represented as follow: 36%, 27%, 22% and 15% of patients were classified in the favourable, intermediate-1, intermediate-2 and unfavourable groups respectively. De novo AML represented 118 out of the 128 patients. 60 patients underwent an allograft, 35 at first remission. 111 patients presented at least one MRD assessment, of whom 75 (68%) by MFC and 84 (76%) by RT-PCR (84 on WT1 and 26 on NPM1 expression). Concordance between both methods was relatively good since results were consistent with both methods for 35 of 44 samples. Interestingly, discordant samples were found in both ways – negative MCF-MRD with positive RT-PCR-MRD or positive MCF-MRD with negative RT-PCR-MRD.The median follow-up was 53 months. 3 years-OS was 61%. 65 patients (51%) relapsed during their follow-up. 3-years RFS was 42%. Patients with negative MRD (either by MCF or RT-PCR) had a better 3-years OS (68% versus 41%, p=0.002) and RFS (51% versus 27%, p=0.0045) than patients with positive MRD. Censoring data at the time of stem cell transplant did not impact the significativity of the results. For patients with only RT-PCR MRD assessment, the benefit of negative MRD was also significant on OS (p=0.0027) and RFS (p=0.0005). Considering only patients with MCF MRD assessment (75 patients), MRD had no significative impact on RFS (p=0.09) and OS (p=0.52).
Conclusion
As previously reported, we found that RT-PCR assessment of MRD is associated with OS and RFS in patients with AML. However only few studies have compared monitoring of MRD by both MCF and RT-PCR at post-induction time. We found a relatively good concordance between both methods. Moreover we showed that using MCF in addition to RT PCR for MRD assessment increased the number of patient that could be monitored at post induction time and was still correlated with outcome.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Flow cytometry, Minimal residual disease (MRD), RT-PCR
Abstract: E892
Type: Eposter Presentation
Background
Minimal residual disease (MRD) assessment is essential during the follow-up of patients with acute myeloid leukemia (AML). Although it is not yet decisional, except in acute promyelocytic leukemia (APL), its evaluation by RT-PCR in AML has already shown a significant impact on survival in AML. Multiparameter Flow Cytometry (MFC) offers another option to monitor MRD, especially for acute leukemias that lack molecular markers. Furthermore, results can be obtained in a shorter timeframes, which could be of great use in the management of AML patients.
Aims
We aim to study MRD assessment by MFC and/or RT-PCR after induction therapy for AML and its impact on outcome.
Methods
Patients were retrospectively included from a database of 182 patients that had at least one MRD assessment for AML during their follow-up from 2005 to 2013. Patients that were diagnosed with AML, who received intensive chemotherapy, that obtained cytologic complete remission after one or two courses of induction-therapy, and that had their initial follow-up in our center were included. Exclusion criteria included APL patients.MRD was assessed by MFC based on leukemia-associated immunophenotype present at diagnosis, including cross-lineage markers and maturation asynchronies. RT-PCR-based MRD was evaluated by quantification of WT1 or NPM1 expression in either blood or bone marrow samples. MRD data were extracted between post-induction hematologic recovery and first consolidation for further analysis. Concordance between MFC and RT-PCR was evaluated for patients who had an MRD evaluation by both methods at the same time. Overall survival (OS) and relapse free survival (RFS) were estimated according to MRD status. OS and RFS were also evaluated after censoring data at the time of stem cell transplant.
Results
128 patients were eligible. Median age at diagnosis was 52 (range: 16 - 73). 36 patients had an initial leucocytosis superior to 50G/L. ELN prognostic groups were represented as follow: 36%, 27%, 22% and 15% of patients were classified in the favourable, intermediate-1, intermediate-2 and unfavourable groups respectively. De novo AML represented 118 out of the 128 patients. 60 patients underwent an allograft, 35 at first remission. 111 patients presented at least one MRD assessment, of whom 75 (68%) by MFC and 84 (76%) by RT-PCR (84 on WT1 and 26 on NPM1 expression). Concordance between both methods was relatively good since results were consistent with both methods for 35 of 44 samples. Interestingly, discordant samples were found in both ways – negative MCF-MRD with positive RT-PCR-MRD or positive MCF-MRD with negative RT-PCR-MRD.The median follow-up was 53 months. 3 years-OS was 61%. 65 patients (51%) relapsed during their follow-up. 3-years RFS was 42%. Patients with negative MRD (either by MCF or RT-PCR) had a better 3-years OS (68% versus 41%, p=0.002) and RFS (51% versus 27%, p=0.0045) than patients with positive MRD. Censoring data at the time of stem cell transplant did not impact the significativity of the results. For patients with only RT-PCR MRD assessment, the benefit of negative MRD was also significant on OS (p=0.0027) and RFS (p=0.0005). Considering only patients with MCF MRD assessment (75 patients), MRD had no significative impact on RFS (p=0.09) and OS (p=0.52).
Conclusion
As previously reported, we found that RT-PCR assessment of MRD is associated with OS and RFS in patients with AML. However only few studies have compared monitoring of MRD by both MCF and RT-PCR at post-induction time. We found a relatively good concordance between both methods. Moreover we showed that using MCF in addition to RT PCR for MRD assessment increased the number of patient that could be monitored at post induction time and was still correlated with outcome.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Flow cytometry, Minimal residual disease (MRD), RT-PCR
Type: Eposter Presentation
Background
Minimal residual disease (MRD) assessment is essential during the follow-up of patients with acute myeloid leukemia (AML). Although it is not yet decisional, except in acute promyelocytic leukemia (APL), its evaluation by RT-PCR in AML has already shown a significant impact on survival in AML. Multiparameter Flow Cytometry (MFC) offers another option to monitor MRD, especially for acute leukemias that lack molecular markers. Furthermore, results can be obtained in a shorter timeframes, which could be of great use in the management of AML patients.
Aims
We aim to study MRD assessment by MFC and/or RT-PCR after induction therapy for AML and its impact on outcome.
Methods
Patients were retrospectively included from a database of 182 patients that had at least one MRD assessment for AML during their follow-up from 2005 to 2013. Patients that were diagnosed with AML, who received intensive chemotherapy, that obtained cytologic complete remission after one or two courses of induction-therapy, and that had their initial follow-up in our center were included. Exclusion criteria included APL patients.MRD was assessed by MFC based on leukemia-associated immunophenotype present at diagnosis, including cross-lineage markers and maturation asynchronies. RT-PCR-based MRD was evaluated by quantification of WT1 or NPM1 expression in either blood or bone marrow samples. MRD data were extracted between post-induction hematologic recovery and first consolidation for further analysis. Concordance between MFC and RT-PCR was evaluated for patients who had an MRD evaluation by both methods at the same time. Overall survival (OS) and relapse free survival (RFS) were estimated according to MRD status. OS and RFS were also evaluated after censoring data at the time of stem cell transplant.
Results
128 patients were eligible. Median age at diagnosis was 52 (range: 16 - 73). 36 patients had an initial leucocytosis superior to 50G/L. ELN prognostic groups were represented as follow: 36%, 27%, 22% and 15% of patients were classified in the favourable, intermediate-1, intermediate-2 and unfavourable groups respectively. De novo AML represented 118 out of the 128 patients. 60 patients underwent an allograft, 35 at first remission. 111 patients presented at least one MRD assessment, of whom 75 (68%) by MFC and 84 (76%) by RT-PCR (84 on WT1 and 26 on NPM1 expression). Concordance between both methods was relatively good since results were consistent with both methods for 35 of 44 samples. Interestingly, discordant samples were found in both ways – negative MCF-MRD with positive RT-PCR-MRD or positive MCF-MRD with negative RT-PCR-MRD.The median follow-up was 53 months. 3 years-OS was 61%. 65 patients (51%) relapsed during their follow-up. 3-years RFS was 42%. Patients with negative MRD (either by MCF or RT-PCR) had a better 3-years OS (68% versus 41%, p=0.002) and RFS (51% versus 27%, p=0.0045) than patients with positive MRD. Censoring data at the time of stem cell transplant did not impact the significativity of the results. For patients with only RT-PCR MRD assessment, the benefit of negative MRD was also significant on OS (p=0.0027) and RFS (p=0.0005). Considering only patients with MCF MRD assessment (75 patients), MRD had no significative impact on RFS (p=0.09) and OS (p=0.52).
Conclusion
As previously reported, we found that RT-PCR assessment of MRD is associated with OS and RFS in patients with AML. However only few studies have compared monitoring of MRD by both MCF and RT-PCR at post-induction time. We found a relatively good concordance between both methods. Moreover we showed that using MCF in addition to RT PCR for MRD assessment increased the number of patient that could be monitored at post induction time and was still correlated with outcome.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Flow cytometry, Minimal residual disease (MRD), RT-PCR
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