Originally published as JCO Early Release 10.1200/JCO.2007.15.9814 on July 7 2008

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Maurillo, L. Articles by Venditti, A. Search for Related Content PubMed PubMed Citation Articles by Maurillo, L. Articles by Venditti, A. Social Bookmarking                            What's this?

Toward Optimization of Postremission Therapy for Residual Disease–Positive Patients With Acute Myeloid Leukemia

Luca Maurillo, Francesco Buccisano, Maria Ilaria Del Principe, Giovanni Del Poeta, Alessandra Spagnoli, Paola Panetta, Emanuele Ammatuna, Benedetta Neri, Licia Ottaviani, Chiara Sarlo, Daniela Venditti, Micol Quaresima, Raffaella Cerretti, Manuela Rizzo, Paolo de Fabritiis, Francesco Lo Coco, William Arcese, Sergio Amadori, Adriano Venditti

From the Hematology, Policlinico Tor Vergata and Ospedale S. Eugenio, Rome, Italy

Corresponding author: Adriano Venditti, MD, Cattedra di Ematologia–Università Tor Vergata, Viale Oxford 81, 00133 Roma, Italia; e-mail: adriano.venditti{at}uniroma2.it

Purpose Despite the identification of several baseline prognostic indicators, the outcome of patients with acute myeloid leukemia (AML) is generally heterogeneous. The effects of autologous (AuSCT) or allogeneic stem-cell transplantation (SCT) are still under evaluation. Minimal residual disease (MRD) states may be essential for assigning patients to therapy-dependent risk categories.

Patients and Methods By multiparametric flow cytometry, we assessed the levels of MRD in 142 patients with AML who achieved complete remission after intensive chemotherapy.

Results A level of 3.5 x 10^–4 residual leukemia cells (RLCs) after consolidation therapy was established to identify MRD-negative and MRD-positive cases, with 5-year relapse-free survival (RFS) rates of 60% and 16%, respectively (P < .0001) and overall survival (OS) rates of 62% and 23%, respectively (P = .0001). Of patients (n = 77) who underwent a transplantation procedure (56 AuSCT and 21 SCT procedures); 42 patients (55%) were MRD positive (28 patients who underwent AuSCT and 14 patients who underwent SCT) and 35 patients (45%) were MRD negative (28 patients who underwent AuSCT and seven who underwent SCT). MRD-negative patients had a favorable prognosis, with only eight (22%) of 35 patients experiencing relapse, whereas 29 (69%) of 42 MRD-positive patients experienced relapse (P < .0001). In this high-risk group of 42 patients, we observed that 23 (82%) of 28 of those who underwent AuSCT experienced relapse, whereas six (43%) of 14 who underwent SCT experienced relapse (P = .014). Patients who underwent SCT also had a higher likelihood of RFS (47% v 14%).

Conclusion A threshold of 3.5 x 10^–4 RLCs postconsolidation is critical for predicting disease outcome. MRD-negative patients have a good outcome regardless of the type of transplant they receive. In the MRD-positive group, AuSCT does not improve prognosis and SCT represents the primary option.

published online ahead of print at www.jco.org on July 7, 2008.

Supported in part by Ministero della Salute (Ricerca Finalizzata Istituto di Ricovero e Cura a Carattere Scientifico and "Alleanza contro il Cancro"), Rome, Italy.

Presented in part at the 48th Annual Meeting of the American Society of Hematology, December 9-12, 2006, Orlando, FL.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?