TY - JOUR
T1 - Use of measurable residual disease to evolve transplant policy in acute myeloid leukemia
T2 - A 20‐year monocentric observation
AU - Buccisano, Francesco
AU - Palmieri, Raffaele
AU - Piciocchi, Alfonso
AU - Maurillo, Luca
AU - Principe, Maria Ilaria Del
AU - Paterno, Giovangiacinto
AU - Soddu, Stefano
AU - Cerretti, Raffaella
AU - De Angelis, Gottardo
AU - Mariotti, Benedetta
AU - Consalvo, Maria Antonietta Irno
AU - Conti, Consuelo
AU - Fraboni, Daniela
AU - Divona, Mariadomenica
AU - Ottone, Tiziana
AU - Lavorgna, Serena
AU - Panetta, Paola
AU - Voso, Maria Teresa
AU - Arcese, William
AU - Venditti, Adriano
N1 - Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/3/1
Y1 - 2021/3/1
N2 - Measurable residual disease (MRD) is increasingly employed as a biomarker of quality of complete remission (CR) in intensively treated acute myeloid leukemia (AML) patients. We evaluated if a MRD‐driven transplant policy improved outcome as compared to a policy solely relying on a familiar donor availability. High‐risk patients (adverse karyotype, FLT3‐ITD) received allogeneic hematopoietic cell transplant (alloHCT) whereas for intermediate and low risk ones (CBF‐AML and NPM1‐mutated), alloHCT or autologous SCT was delivered depending on the postconsolidation measurable residual disease (MRD) status, as assessed by flow cytometry. For comparison, we analyzed a matched historical cohort of patients in whom alloHCT was delivered based on the sole availability of a matched sibling donor. Ten‐years overall and disease‐free survival were longer in the MRD‐driven cohort as compared to the historical cohort (47.7% vs. 28.7%, p = 0.012 and 42.0% vs. 19.5%, p = 0.0003). The favorable impact of this MRD‐driven strategy was evident for the intermediate‐risk category, particularly for MRD positive patients. In the low‐risk category, the significantly lower CIR of the MRD‐driven cohort did not translate into a survival advantage. In conclusion, a MRD‐driven transplant allocation may play a better role than the one based on the simple donor availability. This approach determines a superior outcome of intermediate‐risk patients whereat in low‐risk ones a careful evaluation is needed for transplant allocation.
AB - Measurable residual disease (MRD) is increasingly employed as a biomarker of quality of complete remission (CR) in intensively treated acute myeloid leukemia (AML) patients. We evaluated if a MRD‐driven transplant policy improved outcome as compared to a policy solely relying on a familiar donor availability. High‐risk patients (adverse karyotype, FLT3‐ITD) received allogeneic hematopoietic cell transplant (alloHCT) whereas for intermediate and low risk ones (CBF‐AML and NPM1‐mutated), alloHCT or autologous SCT was delivered depending on the postconsolidation measurable residual disease (MRD) status, as assessed by flow cytometry. For comparison, we analyzed a matched historical cohort of patients in whom alloHCT was delivered based on the sole availability of a matched sibling donor. Ten‐years overall and disease‐free survival were longer in the MRD‐driven cohort as compared to the historical cohort (47.7% vs. 28.7%, p = 0.012 and 42.0% vs. 19.5%, p = 0.0003). The favorable impact of this MRD‐driven strategy was evident for the intermediate‐risk category, particularly for MRD positive patients. In the low‐risk category, the significantly lower CIR of the MRD‐driven cohort did not translate into a survival advantage. In conclusion, a MRD‐driven transplant allocation may play a better role than the one based on the simple donor availability. This approach determines a superior outcome of intermediate‐risk patients whereat in low‐risk ones a careful evaluation is needed for transplant allocation.
KW - AML
KW - Biomarkers
KW - Cytogenetics and molecular markers
KW - MRD
KW - Multiparametric flow cytometry
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U2 - 10.3390/cancers13051083
DO - 10.3390/cancers13051083
M3 - Article
AN - SCOPUS:85101845319
VL - 13
SP - 1
EP - 13
JO - Cancers
JF - Cancers
SN - 2072-6694
IS - 5
M1 - 1083
ER -