MFC -MRD ASSESSMENT MAY DRIVE POST INDUCTION CONSOLIDATION IN INTERMEDIATE RISK AML . IS IT TIME FOR MRD-DRIVEN DECISION MAKING?
(Abstract release date: 05/19/16)
EHA Library. Minetto P. 06/09/16; 132474; E925
Dr. Paola Minetto
Contributions
Contributions
Abstract
Abstract: E925
Type: Eposter Presentation
Background
Since the induction therapy for acute myeloid leukemia (AML) has not changed in the last decades the optimization of post remissional therapeutic strategies is fundamental to improve patients outcome. Allogeneic hematopoietic stem cell transplantation (BMT) offers the greatest chance of cure for most AML patients, however in the heterogeneous group of intermediate cytogenetic risk (int-risk) patients who achieve complete remission (CR) after induction courses, the role of BMT in 1st CR is not well defined.
Aims
The aim of the present study was to evaluate the prognostic role of minimal residual disease (MRD) assessment through multiparameter flow cytometry (MFC-MRD) after 1st and 2nd induction courses in int-risk patients undergoing or not BMT in 1st CR.
Methods
Fifty-five consecutive int-risk AML patients, according to MRC classification, achieving CR after induction therapy, with available post induction MFC-MRD evaluation were retrospectively included in this study. All patients were uniformly treated with a fludarabine-containing induction. Median age was 49 years. BMT in 1st CR was scheduled if an HLA identical sibling donor or, for selected patients, if an haploidentical donor was available. The remaining 34 patients proceeded to high dose cytarabine consolidation and underwent BMT in 2nd CR from any donor if available (6 patients). A positive MFC MRD was defined by the presence of no less than 25 clustered leukemic cells/105 total events at four-color flow-cytometry. Twenty-three and 30 patients achieved MFC MRD negativity after one or two induction cycles, respectively. Median follow up was 44 months. Relapse-free survival (RFS) was calculated from the time of diagnosis until last follow-up or documented leukemic relapse.
Results
Fifty-five consecutive int-risk AML patients, according to MRC classification, achieving CR after induction therapy, with available post induction MFC-MRD evaluation were retrospectively included in this study. All patients were uniformly treated with a fludarabine-containing induction. Median age was 49 years. BMT in 1st CR was scheduled if an HLA identical sibling donor or, for selected patients, if an haploidentical donor was available. The remaining 34 patients proceeded to high dose cytarabine consolidation and underwent BMT in 2nd CR from any donor if available (6 patients). A positive MFC MRD was defined by the presence of no less than 25 clustered leukemic cells/105 total events at four-color flow-cytometry. Twenty-three and 30 patients achieved MFC MRD negativity after one or two induction cycles, respectively. Median follow up was 44 months. Relapse-free survival (RFS) was calculated from the time of diagnosis until last follow-up or documented leukemic relapse.
Conclusion
MFC-MRD assessment after induction therapy is a strong predictor of relapse risk and could improve risk stratification for intermediate patients. A deeper evaluation of MRD through MFC may overcome morphologic CR assessment becoming a powerful tool to delineate the therapeutic iter. Early BMT may improve the outcome of patients with persistence of MRD.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Flow cytometry, Minimal residual disease (MRD)
Type: Eposter Presentation
Background
Since the induction therapy for acute myeloid leukemia (AML) has not changed in the last decades the optimization of post remissional therapeutic strategies is fundamental to improve patients outcome. Allogeneic hematopoietic stem cell transplantation (BMT) offers the greatest chance of cure for most AML patients, however in the heterogeneous group of intermediate cytogenetic risk (int-risk) patients who achieve complete remission (CR) after induction courses, the role of BMT in 1st CR is not well defined.
Aims
The aim of the present study was to evaluate the prognostic role of minimal residual disease (MRD) assessment through multiparameter flow cytometry (MFC-MRD) after 1st and 2nd induction courses in int-risk patients undergoing or not BMT in 1st CR.
Methods
Fifty-five consecutive int-risk AML patients, according to MRC classification, achieving CR after induction therapy, with available post induction MFC-MRD evaluation were retrospectively included in this study. All patients were uniformly treated with a fludarabine-containing induction. Median age was 49 years. BMT in 1st CR was scheduled if an HLA identical sibling donor or, for selected patients, if an haploidentical donor was available. The remaining 34 patients proceeded to high dose cytarabine consolidation and underwent BMT in 2nd CR from any donor if available (6 patients). A positive MFC MRD was defined by the presence of no less than 25 clustered leukemic cells/105 total events at four-color flow-cytometry. Twenty-three and 30 patients achieved MFC MRD negativity after one or two induction cycles, respectively. Median follow up was 44 months. Relapse-free survival (RFS) was calculated from the time of diagnosis until last follow-up or documented leukemic relapse.
Results
Fifty-five consecutive int-risk AML patients, according to MRC classification, achieving CR after induction therapy, with available post induction MFC-MRD evaluation were retrospectively included in this study. All patients were uniformly treated with a fludarabine-containing induction. Median age was 49 years. BMT in 1st CR was scheduled if an HLA identical sibling donor or, for selected patients, if an haploidentical donor was available. The remaining 34 patients proceeded to high dose cytarabine consolidation and underwent BMT in 2nd CR from any donor if available (6 patients). A positive MFC MRD was defined by the presence of no less than 25 clustered leukemic cells/105 total events at four-color flow-cytometry. Twenty-three and 30 patients achieved MFC MRD negativity after one or two induction cycles, respectively. Median follow up was 44 months. Relapse-free survival (RFS) was calculated from the time of diagnosis until last follow-up or documented leukemic relapse.
| Num. (%) | Relapse (%) | median RFS | 3-year RFS (%) | p (univ.) | p (univ.) | ||
| ALL PATIENTS | 55 | 16 (29) | 69 | 71.4 | - | - | |
| MFC MRD after 1st cycle negative | BMT 1st CR | 9/23 (39) | 1 (11) | 62 | 100 | 0.748 | 0.003 |
| No BMT/2nd CR | 14 /23 (61) | 2 (14) | NR | 83.6 | |||
| MFC MRD after 1st cycle positive | BMT 1st CR | 12/32(38) | 1 (8) | NR | 87.5 | 0.048 | |
| No BMT/2nd CR | 20/32 (62) | 12 (60) | 36 | 45.2 | |||
| MFC MRD after 2nd cycle negative | BMT 1st CR | 9/30 (30) | 2 (22) | 62 | 87.5 | 0.790 | 0.098 |
| No BMT/2nd CR | 21/30 (70) | 6 (29) | NR | 77.9 | |||
| MFC MRD after 2nd cycle positive | BMT 1st CR | 8/19 (42) | 0 (0) | NR | 100 | 0.023 | |
| No BMT/2nd CR | 11/19 (58) | 7 (64) | 15 | 33.3 | |||
Conclusion
MFC-MRD assessment after induction therapy is a strong predictor of relapse risk and could improve risk stratification for intermediate patients. A deeper evaluation of MRD through MFC may overcome morphologic CR assessment becoming a powerful tool to delineate the therapeutic iter. Early BMT may improve the outcome of patients with persistence of MRD.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Flow cytometry, Minimal residual disease (MRD)
Abstract: E925
Type: Eposter Presentation
Background
Since the induction therapy for acute myeloid leukemia (AML) has not changed in the last decades the optimization of post remissional therapeutic strategies is fundamental to improve patients outcome. Allogeneic hematopoietic stem cell transplantation (BMT) offers the greatest chance of cure for most AML patients, however in the heterogeneous group of intermediate cytogenetic risk (int-risk) patients who achieve complete remission (CR) after induction courses, the role of BMT in 1st CR is not well defined.
Aims
The aim of the present study was to evaluate the prognostic role of minimal residual disease (MRD) assessment through multiparameter flow cytometry (MFC-MRD) after 1st and 2nd induction courses in int-risk patients undergoing or not BMT in 1st CR.
Methods
Fifty-five consecutive int-risk AML patients, according to MRC classification, achieving CR after induction therapy, with available post induction MFC-MRD evaluation were retrospectively included in this study. All patients were uniformly treated with a fludarabine-containing induction. Median age was 49 years. BMT in 1st CR was scheduled if an HLA identical sibling donor or, for selected patients, if an haploidentical donor was available. The remaining 34 patients proceeded to high dose cytarabine consolidation and underwent BMT in 2nd CR from any donor if available (6 patients). A positive MFC MRD was defined by the presence of no less than 25 clustered leukemic cells/105 total events at four-color flow-cytometry. Twenty-three and 30 patients achieved MFC MRD negativity after one or two induction cycles, respectively. Median follow up was 44 months. Relapse-free survival (RFS) was calculated from the time of diagnosis until last follow-up or documented leukemic relapse.
Results
Fifty-five consecutive int-risk AML patients, according to MRC classification, achieving CR after induction therapy, with available post induction MFC-MRD evaluation were retrospectively included in this study. All patients were uniformly treated with a fludarabine-containing induction. Median age was 49 years. BMT in 1st CR was scheduled if an HLA identical sibling donor or, for selected patients, if an haploidentical donor was available. The remaining 34 patients proceeded to high dose cytarabine consolidation and underwent BMT in 2nd CR from any donor if available (6 patients). A positive MFC MRD was defined by the presence of no less than 25 clustered leukemic cells/105 total events at four-color flow-cytometry. Twenty-three and 30 patients achieved MFC MRD negativity after one or two induction cycles, respectively. Median follow up was 44 months. Relapse-free survival (RFS) was calculated from the time of diagnosis until last follow-up or documented leukemic relapse.
Conclusion
MFC-MRD assessment after induction therapy is a strong predictor of relapse risk and could improve risk stratification for intermediate patients. A deeper evaluation of MRD through MFC may overcome morphologic CR assessment becoming a powerful tool to delineate the therapeutic iter. Early BMT may improve the outcome of patients with persistence of MRD.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Flow cytometry, Minimal residual disease (MRD)
Type: Eposter Presentation
Background
Since the induction therapy for acute myeloid leukemia (AML) has not changed in the last decades the optimization of post remissional therapeutic strategies is fundamental to improve patients outcome. Allogeneic hematopoietic stem cell transplantation (BMT) offers the greatest chance of cure for most AML patients, however in the heterogeneous group of intermediate cytogenetic risk (int-risk) patients who achieve complete remission (CR) after induction courses, the role of BMT in 1st CR is not well defined.
Aims
The aim of the present study was to evaluate the prognostic role of minimal residual disease (MRD) assessment through multiparameter flow cytometry (MFC-MRD) after 1st and 2nd induction courses in int-risk patients undergoing or not BMT in 1st CR.
Methods
Fifty-five consecutive int-risk AML patients, according to MRC classification, achieving CR after induction therapy, with available post induction MFC-MRD evaluation were retrospectively included in this study. All patients were uniformly treated with a fludarabine-containing induction. Median age was 49 years. BMT in 1st CR was scheduled if an HLA identical sibling donor or, for selected patients, if an haploidentical donor was available. The remaining 34 patients proceeded to high dose cytarabine consolidation and underwent BMT in 2nd CR from any donor if available (6 patients). A positive MFC MRD was defined by the presence of no less than 25 clustered leukemic cells/105 total events at four-color flow-cytometry. Twenty-three and 30 patients achieved MFC MRD negativity after one or two induction cycles, respectively. Median follow up was 44 months. Relapse-free survival (RFS) was calculated from the time of diagnosis until last follow-up or documented leukemic relapse.
Results
Fifty-five consecutive int-risk AML patients, according to MRC classification, achieving CR after induction therapy, with available post induction MFC-MRD evaluation were retrospectively included in this study. All patients were uniformly treated with a fludarabine-containing induction. Median age was 49 years. BMT in 1st CR was scheduled if an HLA identical sibling donor or, for selected patients, if an haploidentical donor was available. The remaining 34 patients proceeded to high dose cytarabine consolidation and underwent BMT in 2nd CR from any donor if available (6 patients). A positive MFC MRD was defined by the presence of no less than 25 clustered leukemic cells/105 total events at four-color flow-cytometry. Twenty-three and 30 patients achieved MFC MRD negativity after one or two induction cycles, respectively. Median follow up was 44 months. Relapse-free survival (RFS) was calculated from the time of diagnosis until last follow-up or documented leukemic relapse.
| Num. (%) | Relapse (%) | median RFS | 3-year RFS (%) | p (univ.) | p (univ.) | ||
| ALL PATIENTS | 55 | 16 (29) | 69 | 71.4 | - | - | |
| MFC MRD after 1st cycle negative | BMT 1st CR | 9/23 (39) | 1 (11) | 62 | 100 | 0.748 | 0.003 |
| No BMT/2nd CR | 14 /23 (61) | 2 (14) | NR | 83.6 | |||
| MFC MRD after 1st cycle positive | BMT 1st CR | 12/32(38) | 1 (8) | NR | 87.5 | 0.048 | |
| No BMT/2nd CR | 20/32 (62) | 12 (60) | 36 | 45.2 | |||
| MFC MRD after 2nd cycle negative | BMT 1st CR | 9/30 (30) | 2 (22) | 62 | 87.5 | 0.790 | 0.098 |
| No BMT/2nd CR | 21/30 (70) | 6 (29) | NR | 77.9 | |||
| MFC MRD after 2nd cycle positive | BMT 1st CR | 8/19 (42) | 0 (0) | NR | 100 | 0.023 | |
| No BMT/2nd CR | 11/19 (58) | 7 (64) | 15 | 33.3 | |||
Conclusion
MFC-MRD assessment after induction therapy is a strong predictor of relapse risk and could improve risk stratification for intermediate patients. A deeper evaluation of MRD through MFC may overcome morphologic CR assessment becoming a powerful tool to delineate the therapeutic iter. Early BMT may improve the outcome of patients with persistence of MRD.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Flow cytometry, Minimal residual disease (MRD)
{{ help_message }}
{{filter}}