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Mannis GN, Martin TG, Damon LE, Logan AC, Olin RL, Flanders MD, Ai WZ, Gaensler KML, Kaplan LD, Sayre PH, Smith CC, Wolf JL, Andreadis C. Long-term outcomes of patients with intermediate-risk acute myeloid leukemia treated with autologous hematopoietic cell transplant in first complete remission. Leuk Lymphoma 2016; 57:1560-6. [PMID: 26490487 DOI: 10.3109/10428194.2015.1088646] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In 2014, autologous hematopoietic cell transplant (autoHCT) was removed from the National Comprehensive Cancer Network guidelines as a recommended treatment for patients with intermediate-risk AML in first complete remission (CR1). We reviewed the outcomes of all patients with intermediate-risk AML treated with autoHCT in CR1 at our institution. Of 334 patients who underwent autoHCT for AML between 1988 and 2013, 133 patients with intermediate-risk AML in CR1 were identified. Cytogenetics were diploid in 97 (73%). With a median follow-up of 4.1 years (range 0.1-17), median overall survival (OS) is 6.7 years; at 5 years post-transplant, 59% of patients remain alive and 43% remain relapse-free. Forty-eight percent of relapsing patients proceeded to salvage alloHCT. Our findings demonstrate that nearly half of patients with intermediate-risk AML in CR1 achieve sustained remissions, and that salvage alloHCT is feasible in those who relapse. AutoHCT therefore remains a reasonable option for intermediate-risk patients with AML in CR1.
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Affiliation(s)
- Gabriel N Mannis
- a Department of Medicine, Division of Hematology and Blood and Marrow Transplantation , Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco , San Francisco , CA , USA
| | - Thomas G Martin
- a Department of Medicine, Division of Hematology and Blood and Marrow Transplantation , Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco , San Francisco , CA , USA
| | - Lloyd E Damon
- a Department of Medicine, Division of Hematology and Blood and Marrow Transplantation , Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco , San Francisco , CA , USA
| | - Aaron C Logan
- a Department of Medicine, Division of Hematology and Blood and Marrow Transplantation , Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco , San Francisco , CA , USA
| | - Rebecca L Olin
- a Department of Medicine, Division of Hematology and Blood and Marrow Transplantation , Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco , San Francisco , CA , USA
| | - Michael D Flanders
- a Department of Medicine, Division of Hematology and Blood and Marrow Transplantation , Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco , San Francisco , CA , USA
| | - Weiyun Z Ai
- a Department of Medicine, Division of Hematology and Blood and Marrow Transplantation , Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco , San Francisco , CA , USA
| | - Karin M L Gaensler
- a Department of Medicine, Division of Hematology and Blood and Marrow Transplantation , Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco , San Francisco , CA , USA
| | - Lawrence D Kaplan
- a Department of Medicine, Division of Hematology and Blood and Marrow Transplantation , Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco , San Francisco , CA , USA
| | - Peter H Sayre
- a Department of Medicine, Division of Hematology and Blood and Marrow Transplantation , Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco , San Francisco , CA , USA
| | - Catherine C Smith
- a Department of Medicine, Division of Hematology and Blood and Marrow Transplantation , Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco , San Francisco , CA , USA
| | - Jeffrey L Wolf
- a Department of Medicine, Division of Hematology and Blood and Marrow Transplantation , Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco , San Francisco , CA , USA
| | - Charalambos Andreadis
- a Department of Medicine, Division of Hematology and Blood and Marrow Transplantation , Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco , San Francisco , CA , USA
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Abstract
PURPOSE OF REVIEW Early bone marrow evaluation on day 14 of induction is common practice assisting in decision making regarding reinduction need in acute myeloid leukemia (AML). Studies exploring day 14 bone marrow false positive and negative rates yielded diverse data, and a highly specific method for early bone marrow evaluation is warranted. Given the improved induction-associated death rate, the risk of redundant reinduction administered to patients anticipating remission with one induction cycle may be outweighed by the benefit from the potential reduction in the falsely interpreted nadir bone marrow. The purpose of this review is to analyze current evidence on ways to optimize early bone marrow evaluation during induction in AML. RECENT FINDINGS Day 14 bone marrow blast count is affected by patient's age, leukemic risk, and induction regimen, and its remission prediction power is enhanced if more stringent cutoffs are used to define significant residual blast numbers or if morphologic bone marrow evaluation is performed on day 5 of induction. SUMMARY Early bone marrow evaluation has a potential to personalize the induction regimen, but because of limitations of day 14 bone marrow results, earlier bone marrow evaluation or the use of flow cytometry to detect minor blast populations may improve remission prediction in AML.
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103
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Rambaldi A, Grassi A, Masciulli A, Boschini C, Micò MC, Busca A, Bruno B, Cavattoni I, Santarone S, Raimondi R, Montanari M, Milone G, Chiusolo P, Pastore D, Guidi S, Patriarca F, Risitano AM, Saporiti G, Pini M, Terruzzi E, Arcese W, Marotta G, Carella AM, Nagler A, Russo D, Corradini P, Alessandrino EP, Torelli GF, Scimè R, Mordini N, Oldani E, Marfisi RM, Bacigalupo A, Bosi A. Busulfan plus cyclophosphamide versus busulfan plus fludarabine as a preparative regimen for allogeneic haemopoietic stem-cell transplantation in patients with acute myeloid leukaemia: an open-label, multicentre, randomised, phase 3 trial. Lancet Oncol 2015; 16:1525-1536. [DOI: 10.1016/s1470-2045(15)00200-4] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 07/22/2015] [Accepted: 07/24/2015] [Indexed: 10/23/2022]
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104
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Versluis J, Hazenberg CLE, Passweg JR, van Putten WLJ, Maertens J, Biemond BJ, Theobald M, Graux C, Kuball J, Schouten HC, Pabst T, Löwenberg B, Ossenkoppele G, Vellenga E, Cornelissen JJ. Post-remission treatment with allogeneic stem cell transplantation in patients aged 60 years and older with acute myeloid leukaemia: a time-dependent analysis. LANCET HAEMATOLOGY 2015; 2:e427-36. [DOI: 10.1016/s2352-3026(15)00148-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 08/04/2015] [Accepted: 08/05/2015] [Indexed: 10/23/2022]
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105
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Autologous stem cell transplantation for adult acute leukemia in 2015: time to rethink? Present status and future prospects. Bone Marrow Transplant 2015; 50:1495-502. [PMID: 26281031 DOI: 10.1038/bmt.2015.179] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 06/25/2015] [Accepted: 06/26/2015] [Indexed: 01/22/2023]
Abstract
The use of autologous stem cell transplantation (ASCT) as consolidation therapy for adult patients with acute leukemia has declined over time. However, multiple randomized studies in the past have reported lower relapse rates after autologous transplantation compared with chemotherapy and lower non-relapse mortality rates compared with allogeneic transplantation. In addition, quality of life of long-term survivors is better after autologous transplantation than after allogeneic transplantation. Further, recent developments may improve outcomes of autograft recipients. These include the use of IV busulfan and the busulfan+melphalan combination, better detection of minimal residual disease (MRD) with molecular biology techniques, the introduction of targeted therapies and post-transplant maintenance therapy. Therefore, ASCT may nowadays be reconsidered for consolidation in the following patients if and when they reach a MRD-negative status: good- and at least intermediate-1 risk acute myelocytic leukemia in first CR, acute promyelocytic leukemia in second CR, Ph-positive acute lymphocytic leukemia. Conversely, patients with MRD-positive status or high-risk leukemia should not be considered for consolidation with ASCT.
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106
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Yu C, Kong QL, Zhang YX, Weng XQ, Wu J, Sheng Y, Jiang CL, Zhu YM, Cao Q, Xiong SM, Li JM, Xi XD, Chen SJ, Chen B. Clinical significance of day 5 peripheral blast clearance rate in the evaluation of early treatment response and prognosis of patients with acute myeloid leukemia. J Hematol Oncol 2015; 8:48. [PMID: 25957890 PMCID: PMC4431040 DOI: 10.1186/s13045-015-0145-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/28/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Minimal residual disease detection in the bone marrow is usually performed in patients with acute myeloid leukemia undergoing one course of induction chemotherapy. To optimize the chemotherapy strategies, more practical and sensitive markers are needed to monitor the early treatment response during induction. For instance, peripheral blood (PB) blast clearance rate may be considered as such a monitoring marker. METHODS PB blasts were monitored through multiparameter flow cytometry (MFC). Absolute counts were determined before treatment (D0) and at specified time points of induction chemotherapy (D3, D5, D7, and D9). The cut-off value of D5 peripheral blast clearance rate (D5-PBCR) was defined through receiver operating characteristic (ROC) analysis. Prognostic effects were compared among different patient groups according to D5-PBCR cut-off value. RESULTS D5-PBCR cut-off value was determined as 99.55%. Prognostic analysis showed that patients with D5-PBCR ≥99.55% more likely achieved complete remission (94.6% vs. 56.1%, P < 0.001) and maintained a relapse-free status than other patients (80.56% vs. 57.14%, P = 0.027). Survival analysis revealed that relapse-free survival (RFS) and overall survival (OS) were longer in patients with D5-PBCR ≥99.55% than in other patients (two-year OS: 71.0% vs. 38.7%, P = 0.011; two-year RFS: 69.4% vs. 30.7%, P = 0.026). In cytogenetic-molecular intermediate-risk group, a subgroup with worse outcome could be distinguished on the basis of D5-PBCR (<99.55%; OS: P = 0.033, RFS: P = 0.086). CONCLUSIONS An effective evaluation method of early treatment response was established by monitoring PB blasts through MFC. D5-PBCR cut-off value (99.55%) can be a reliable reference to predict treatment response and outcome in early stages of chemotherapy. The proposed marker may be used in induction regimen modification and help optimize cytogenetic-molecular prognostic risk stratification.
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Affiliation(s)
- Cong Yu
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital, affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine, Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China.
| | - Qing-lei Kong
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital, affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine, Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China.
| | - Yun-xiang Zhang
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital, affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine, Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China.
| | - Xiang-qin Weng
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital, affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine, Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China.
| | - Jing Wu
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital, affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine, Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China.
| | - Yan Sheng
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital, affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine, Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China.
| | - Chun-lei Jiang
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital, affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine, Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China.
| | - Yong-mei Zhu
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital, affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine, Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China.
| | - Qi Cao
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital, affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine, Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China.
| | - Shu-min Xiong
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital, affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine, Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China.
| | - Jun-min Li
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital, affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine, Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China.
| | - Xiao-dong Xi
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital, affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine, Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China.
| | - Sai-juan Chen
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital, affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine, Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China.
| | - Bing Chen
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital, affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine, Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China.
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107
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Abstract
Acute myeloid leukemia (AML) in older patients presents a notable therapeutic challenge to the clinical hematologist. The clinical biology of AML among patients is highly heterogeneous. Interpatient variations are relevant for prognosis and treatment choice. Outcome of treatment for patients of advanced age is often compromised by comorbid conditions and an enhanced susceptibility to toxicities from therapy. Here we present selected clinical vignettes that highlight distinct representative situations derived from clinical practice. The vignettes are specifically discussed in light of the perspective of treating older patients with leukemia. We review the clinical significance of various cytogenetic and molecular features of the disease, and we examine the various currently available treatment options as well as the emerging prognostic algorithms that may offer guidance in regard to personalized therapy recommendations. The dilemmas in tailoring treatment selection in this category of patients with AML are the central theme in this discussion.
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