Pretransplant minimal residual disease level predicts clinical outcome in patients with acute myeloid leukemia receiving high-dose chemotherapy and autologous stem cell transplantation

A. Venditti, L. Maurillo, F. Buccisano, G. Del Poeta, C. Mazzone, A. Tamburini, M. I. Del Principe, M. I. Consalvo, P. De Fabritiis, L. Cudillo, A. Picardi, A. Franchi, F. L. Coco, S. Amadori

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Abstract

A total of 31 adult patients with AML entered in the EORTC/GIMEMA AML-10 trial, who received autologous stem cell transplantation (ASCT) after induction and consolidation chemotherapy, were prospectively evaluated for minimal residual disease (MRD) by multidimensional flow cytometry (MFC). Using a cutoff level of 3.5 × 10-4 leukemic cells pre-ASCT, 12 patients (39%) were stratified to MRD high-risk group and 19 (61%) into MRD low-risk group. During follow-up, all patients who were in the high-risk group relapsed at a median time of 7 months; in the low-risk group, five patients relapsed at a median time of 11 months and 14 remained in remission for 56 (range 7-80) months (P=0.00004). Longitudinal MFC determinations post-ASCT showed increased MRD levels in three of the five patients who underwent subsequent relapse, while disease recurrence was unpredicted in the remaining two cases. The pre-ASCT MRD status was the factor most strongly associated with relapse risk in the multivariate analysis (P=0.0014). We conclude that: (1) pre-ASCT MRD status predicts successful outcome in patients receiving ASCT; (2) high-dose chemotherapy conditioning regimen followed by ASCT has no impact on the unfavorable prognostic value of high pre-ASCT MRD level; and (3) sequential MRD monitoring post-ASCT may allow the prediction of impending relapse.

Original languageEnglish
Pages (from-to)2178-2182
Number of pages5
JournalLeukemia
Volume17
Issue number11
DOIs
Publication statusPublished - Nov 2003

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Residual Neoplasm
Stem Cell Transplantation
Acute Myeloid Leukemia
Drug Therapy
Recurrence
Flow Cytometry
Consolidation Chemotherapy
Induction Chemotherapy
Multivariate Analysis

Keywords

  • AML
  • ASCT
  • MRD

ASJC Scopus subject areas

  • Hematology
  • Cancer Research

Cite this

Pretransplant minimal residual disease level predicts clinical outcome in patients with acute myeloid leukemia receiving high-dose chemotherapy and autologous stem cell transplantation. / Venditti, A.; Maurillo, L.; Buccisano, F.; Del Poeta, G.; Mazzone, C.; Tamburini, A.; Del Principe, M. I.; Consalvo, M. I.; De Fabritiis, P.; Cudillo, L.; Picardi, A.; Franchi, A.; Coco, F. L.; Amadori, S.

In: Leukemia, Vol. 17, No. 11, 11.2003, p. 2178-2182.

Research output: Contribution to journalArticle

Venditti, A, Maurillo, L, Buccisano, F, Del Poeta, G, Mazzone, C, Tamburini, A, Del Principe, MI, Consalvo, MI, De Fabritiis, P, Cudillo, L, Picardi, A, Franchi, A, Coco, FL & Amadori, S 2003, 'Pretransplant minimal residual disease level predicts clinical outcome in patients with acute myeloid leukemia receiving high-dose chemotherapy and autologous stem cell transplantation', Leukemia, vol. 17, no. 11, pp. 2178-2182. https://doi.org/10.1038/sj.leu.2403138
Venditti, A. ; Maurillo, L. ; Buccisano, F. ; Del Poeta, G. ; Mazzone, C. ; Tamburini, A. ; Del Principe, M. I. ; Consalvo, M. I. ; De Fabritiis, P. ; Cudillo, L. ; Picardi, A. ; Franchi, A. ; Coco, F. L. ; Amadori, S. / Pretransplant minimal residual disease level predicts clinical outcome in patients with acute myeloid leukemia receiving high-dose chemotherapy and autologous stem cell transplantation. In: Leukemia. 2003 ; Vol. 17, No. 11. pp. 2178-2182.
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AU - Venditti, A.

AU - Maurillo, L.

AU - Buccisano, F.

AU - Del Poeta, G.

AU - Mazzone, C.

AU - Tamburini, A.

AU - Del Principe, M. I.

AU - Consalvo, M. I.

AU - De Fabritiis, P.

AU - Cudillo, L.

AU - Picardi, A.

AU - Franchi, A.

AU - Coco, F. L.

AU - Amadori, S.

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AB - A total of 31 adult patients with AML entered in the EORTC/GIMEMA AML-10 trial, who received autologous stem cell transplantation (ASCT) after induction and consolidation chemotherapy, were prospectively evaluated for minimal residual disease (MRD) by multidimensional flow cytometry (MFC). Using a cutoff level of 3.5 × 10-4 leukemic cells pre-ASCT, 12 patients (39%) were stratified to MRD high-risk group and 19 (61%) into MRD low-risk group. During follow-up, all patients who were in the high-risk group relapsed at a median time of 7 months; in the low-risk group, five patients relapsed at a median time of 11 months and 14 remained in remission for 56 (range 7-80) months (P=0.00004). Longitudinal MFC determinations post-ASCT showed increased MRD levels in three of the five patients who underwent subsequent relapse, while disease recurrence was unpredicted in the remaining two cases. The pre-ASCT MRD status was the factor most strongly associated with relapse risk in the multivariate analysis (P=0.0014). We conclude that: (1) pre-ASCT MRD status predicts successful outcome in patients receiving ASCT; (2) high-dose chemotherapy conditioning regimen followed by ASCT has no impact on the unfavorable prognostic value of high pre-ASCT MRD level; and (3) sequential MRD monitoring post-ASCT may allow the prediction of impending relapse.

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