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Prassek VV, Rothenberg-Thurley M, Sauerland MC, Herold T, Janke H, Ksienzyk B, Konstandin NP, Goerlich D, Krug U, Faldum A, Berdel WE, Wörmann B, Braess J, Schneider S, Subklewe M, Bohlander SK, Hiddemann W, Spiekermann K, Metzeler KH. Genetics of acute myeloid leukemia in the elderly: mutation spectrum and clinical impact in intensively treated patients aged 75 years or older. Haematologica 2018; 103:1853-1861. [PMID: 29903761 PMCID: PMC6278991 DOI: 10.3324/haematol.2018.191536] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/11/2018] [Indexed: 11/09/2022] Open
Abstract
A cute myeloid leukemia is a disease of the elderly (median age at diagnosis, 65-70 years). The prognosis of older acute myeloid leukemia patients is generally poor. While genetic markers have become important tools for risk stratification and treatment selection in young and middle-aged patients, their applicability in very old patients is less clear. We sought to validate existing genetic risk classification systems and identify additional factors associated with outcomes in intensively treated patients aged ≥75 years. In 151 patients who received induction chemotherapy in the AMLCG-1999 trial, we investigated recurrently mutated genes using a targeted sequencing assay covering 64 genes. The median number of mutated genes per patient was four. The most commonly mutated genes were TET2 (42%), DNMT3A (35%), NPM1 (32%), SRSF2 (25%) and ASXL1 (21%). The complete remission rate was 44% and the 3-year survival was 21% for the entire cohort. While adverse-risk cytogenetics (MRC classification) were associated with shorter overall survival (P=0.001), NPM1 and FLT3-ITD mutations (present in 18%) did not have a significant impact on overall survival. Notably, none of the 13 IDH1-mutated patients (9%) reached complete remission. Consequently, the overall survival of this subgroup was significantly shorter than that of IDH1-wildtype patients (P<0.001). In summary, even among very old, intensively treated, acute myeloid leukemia patients, adverse-risk cytogenetics predict inferior survival. The spectrum and relevance of driver gene mutations in elderly patients differs from that in younger patients. Our data implicate IDH1 mutations as a novel marker for chemorefractory disease and inferior prognosis. (AMLCG-1999 trial: clinicaltrials.gov identifier, NCT00266136).
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Affiliation(s)
- Victoria V Prassek
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Maja Rothenberg-Thurley
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Maria C Sauerland
- Institute of Biostatistics and Clinical Research, University of Münster, Germany
| | - Tobias Herold
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hanna Janke
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Bianka Ksienzyk
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Nikola P Konstandin
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Dennis Goerlich
- Institute of Biostatistics and Clinical Research, University of Münster, Germany
| | | | - Andreas Faldum
- Institute of Biostatistics and Clinical Research, University of Münster, Germany
| | - Wolfgang E Berdel
- Institute of Biostatistics and Clinical Research, University of Münster, Germany
| | | | - Jan Braess
- Department of Oncology and Hematology, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Stephanie Schneider
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Marion Subklewe
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Stefan K Bohlander
- Department of Molecular Medicine and Pathology, University of Auckland, New Zealand
| | - Wolfgang Hiddemann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Karsten Spiekermann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Klaus H Metzeler
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Germany .,German Cancer Consortium (DKTK), Partner Site Munich, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
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6
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Oran B, Jimenez AM, De Lima M, Popat UR, Bassett R, Andersson B, Borthakur G, Bashir Q, Chen J, Ciurea SO, Jabbour E, Cortes J, Kebriaei P, Khouri IF, Qazilbash MH, Ravandi F, Rondon G, Lu X, Shpall EJ, Champlin RE. Age and Modified European LeukemiaNet Classification to Predict Transplant Outcomes: An Integrated Approach for Acute Myelogenous Leukemia Patients Undergoing Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2015; 21:1405-1412. [PMID: 25840338 DOI: 10.1016/j.bbmt.2015.03.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/25/2015] [Indexed: 12/20/2022]
Abstract
We evaluated the prognostic significance of a modified European LeukemiaNet (ELN) classification for patients with acute myelogenous leukemia (AML) undergoing hematopoietic stem cell transplantation (HSCT) while in first complete remission (CR1). We analyzed 464 AML patients with matched related (n = 211, 45.5%), matched unrelated (n = 176, 37.9%), and mismatched donors (n = 77, 16.6%). Patients were classified into 4 modified ELN risk groups (favorable, intermediate-I, intermediate-II, and adverse) separately for 354 patients age < 60 years and 110 patients age ≥ 60 years. In this modified version of ELN classification, patients with normal cytogenetic were classified by FLT3-ITD mutational status: favorable risk if FLT3-ITDwild and intermediate-I if FLT3-ITDmut. The best outcomes occurred in the ELN favorable and intermediate-II groups in younger AML patients and in the favorable and intermediate-I groups in older AML patients. Older AML patients had worse transplant outcomes within each modified ELN risk group except intermediate-I when compared with younger patients; leukemia-free survival at 3 years was 67.8% versus 49.8% in favorable, 53.4% versus 50.7% in intermediate-I, 65.7% versus 20.2% in intermediate-II, and 44.6% versus 23.8% in adverse group younger and older patients, respectively. Among lesion-specific abnormalities, del5q/-5 and abnl(17p) had the worse transplant outcomes, with 3-year leukemia-free survival rates of 18.4% and 20% in younger CR1 patients. In conclusion, the modified ELN prognostic classification developed for chemotherapy outcomes also identifies prognostic groups for HSCT, which is useful for a selection of patients for post-transplant strategies to improve outcomes.
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Affiliation(s)
- Betül Oran
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Antonio M Jimenez
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marcos De Lima
- University Hospitals and Case Western Reserve University, , Cleveland, OH
| | - Uday R Popat
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Roland Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Borje Andersson
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Qaiser Bashir
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Julianne Chen
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stefan O Ciurea
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jorge Cortes
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Issa F Khouri
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Muzaffar H Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gabriela Rondon
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xinyan Lu
- Department of Hematopathology; The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
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12
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Röllig C, Bornhäuser M, Thiede C, Taube F, Kramer M, Mohr B, Aulitzky W, Bodenstein H, Tischler HJ, Stuhlmann R, Schuler U, Stölzel F, von Bonin M, Wandt H, Schäfer-Eckart K, Schaich M, Ehninger G. Long-Term Prognosis of Acute Myeloid Leukemia According to the New Genetic Risk Classification of the European LeukemiaNet Recommendations: Evaluation of the Proposed Reporting System. J Clin Oncol 2011; 29:2758-65. [DOI: 10.1200/jco.2010.32.8500] [Citation(s) in RCA: 183] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The current European LeukemiaNet (ELN) recommendations for acute myeloid leukemia (AML) propose a new risk reporting system, integrating molecular and cytogenetic factors and subdividing the large heterogenous group of intermediate-risk patients into intermediate-I (IR-I) and intermediate-II (IR-II). We assessed the prognostic value of the new risk classification in a large cohort of patients. Patients and Methods Complete data for classification were available for 1,557 of 1,862 patients treated in the AML96 trial. Patients were assigned to the proposed genetic groups from the ELN recommendations, and survival analyses were performed using the Kaplan-Meier method and log-rank test for significance testing. Results The median age of all patients was 67 years. With a median follow-up of 8.3 years, significant differences between all risk categories were observed in patients age ≤ 60 years regarding the time to relapse, relapse-free survival, and overall survival (OS). Patients in the IR-II group had a better prognosis than patients in the IR-I group. The median OS times in young patients with favorable risk (FR), IR-I, IR-II, and adverse risk (AR) were 5.3, 1.1, 1.6, and 0.5 years, respectively. Separate analyses in the age group older than 60 years revealed significant differences between FR, AR, and IR as a whole, but not between IR-I and IR-II. Conclusion In younger patients with AML, the ELN classification seems to be the best available framework for prognostic estimations to date. Caution is advised concerning its use for prospective treatment allocation before it has been prospectively validated. In elderly patients, alternative prognostic factors are desirable for further risk stratification of IR.
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Affiliation(s)
- Christoph Röllig
- Christoph Röllig, Martin Bornhäuser, Christian Thiede, Franziska Taube, Michael Kramer, Brigitte Mohr, Ulrich Schuler, Friedrich Stölzel, Malte von Bonin, Markus Schaich, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden; Walter Aulitzky, Robert-Bosch-Krankenhaus Abteilung für Hämatologie, Onkologie und Palliativmedizin, Stuttgart; Heinrich Bodenstein and Hans-Joachim Tischler, Klinikum Minden, Klinik für Hämatologie und Onkologie, Minden; Reingard
| | - Martin Bornhäuser
- Christoph Röllig, Martin Bornhäuser, Christian Thiede, Franziska Taube, Michael Kramer, Brigitte Mohr, Ulrich Schuler, Friedrich Stölzel, Malte von Bonin, Markus Schaich, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden; Walter Aulitzky, Robert-Bosch-Krankenhaus Abteilung für Hämatologie, Onkologie und Palliativmedizin, Stuttgart; Heinrich Bodenstein and Hans-Joachim Tischler, Klinikum Minden, Klinik für Hämatologie und Onkologie, Minden; Reingard
| | - Christian Thiede
- Christoph Röllig, Martin Bornhäuser, Christian Thiede, Franziska Taube, Michael Kramer, Brigitte Mohr, Ulrich Schuler, Friedrich Stölzel, Malte von Bonin, Markus Schaich, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden; Walter Aulitzky, Robert-Bosch-Krankenhaus Abteilung für Hämatologie, Onkologie und Palliativmedizin, Stuttgart; Heinrich Bodenstein and Hans-Joachim Tischler, Klinikum Minden, Klinik für Hämatologie und Onkologie, Minden; Reingard
| | - Franziska Taube
- Christoph Röllig, Martin Bornhäuser, Christian Thiede, Franziska Taube, Michael Kramer, Brigitte Mohr, Ulrich Schuler, Friedrich Stölzel, Malte von Bonin, Markus Schaich, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden; Walter Aulitzky, Robert-Bosch-Krankenhaus Abteilung für Hämatologie, Onkologie und Palliativmedizin, Stuttgart; Heinrich Bodenstein and Hans-Joachim Tischler, Klinikum Minden, Klinik für Hämatologie und Onkologie, Minden; Reingard
| | - Michael Kramer
- Christoph Röllig, Martin Bornhäuser, Christian Thiede, Franziska Taube, Michael Kramer, Brigitte Mohr, Ulrich Schuler, Friedrich Stölzel, Malte von Bonin, Markus Schaich, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden; Walter Aulitzky, Robert-Bosch-Krankenhaus Abteilung für Hämatologie, Onkologie und Palliativmedizin, Stuttgart; Heinrich Bodenstein and Hans-Joachim Tischler, Klinikum Minden, Klinik für Hämatologie und Onkologie, Minden; Reingard
| | - Brigitte Mohr
- Christoph Röllig, Martin Bornhäuser, Christian Thiede, Franziska Taube, Michael Kramer, Brigitte Mohr, Ulrich Schuler, Friedrich Stölzel, Malte von Bonin, Markus Schaich, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden; Walter Aulitzky, Robert-Bosch-Krankenhaus Abteilung für Hämatologie, Onkologie und Palliativmedizin, Stuttgart; Heinrich Bodenstein and Hans-Joachim Tischler, Klinikum Minden, Klinik für Hämatologie und Onkologie, Minden; Reingard
| | - Walter Aulitzky
- Christoph Röllig, Martin Bornhäuser, Christian Thiede, Franziska Taube, Michael Kramer, Brigitte Mohr, Ulrich Schuler, Friedrich Stölzel, Malte von Bonin, Markus Schaich, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden; Walter Aulitzky, Robert-Bosch-Krankenhaus Abteilung für Hämatologie, Onkologie und Palliativmedizin, Stuttgart; Heinrich Bodenstein and Hans-Joachim Tischler, Klinikum Minden, Klinik für Hämatologie und Onkologie, Minden; Reingard
| | - Heinrich Bodenstein
- Christoph Röllig, Martin Bornhäuser, Christian Thiede, Franziska Taube, Michael Kramer, Brigitte Mohr, Ulrich Schuler, Friedrich Stölzel, Malte von Bonin, Markus Schaich, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden; Walter Aulitzky, Robert-Bosch-Krankenhaus Abteilung für Hämatologie, Onkologie und Palliativmedizin, Stuttgart; Heinrich Bodenstein and Hans-Joachim Tischler, Klinikum Minden, Klinik für Hämatologie und Onkologie, Minden; Reingard
| | - Hans-Joachim Tischler
- Christoph Röllig, Martin Bornhäuser, Christian Thiede, Franziska Taube, Michael Kramer, Brigitte Mohr, Ulrich Schuler, Friedrich Stölzel, Malte von Bonin, Markus Schaich, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden; Walter Aulitzky, Robert-Bosch-Krankenhaus Abteilung für Hämatologie, Onkologie und Palliativmedizin, Stuttgart; Heinrich Bodenstein and Hans-Joachim Tischler, Klinikum Minden, Klinik für Hämatologie und Onkologie, Minden; Reingard
| | - Reingard Stuhlmann
- Christoph Röllig, Martin Bornhäuser, Christian Thiede, Franziska Taube, Michael Kramer, Brigitte Mohr, Ulrich Schuler, Friedrich Stölzel, Malte von Bonin, Markus Schaich, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden; Walter Aulitzky, Robert-Bosch-Krankenhaus Abteilung für Hämatologie, Onkologie und Palliativmedizin, Stuttgart; Heinrich Bodenstein and Hans-Joachim Tischler, Klinikum Minden, Klinik für Hämatologie und Onkologie, Minden; Reingard
| | - Ulrich Schuler
- Christoph Röllig, Martin Bornhäuser, Christian Thiede, Franziska Taube, Michael Kramer, Brigitte Mohr, Ulrich Schuler, Friedrich Stölzel, Malte von Bonin, Markus Schaich, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden; Walter Aulitzky, Robert-Bosch-Krankenhaus Abteilung für Hämatologie, Onkologie und Palliativmedizin, Stuttgart; Heinrich Bodenstein and Hans-Joachim Tischler, Klinikum Minden, Klinik für Hämatologie und Onkologie, Minden; Reingard
| | - Friedrich Stölzel
- Christoph Röllig, Martin Bornhäuser, Christian Thiede, Franziska Taube, Michael Kramer, Brigitte Mohr, Ulrich Schuler, Friedrich Stölzel, Malte von Bonin, Markus Schaich, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden; Walter Aulitzky, Robert-Bosch-Krankenhaus Abteilung für Hämatologie, Onkologie und Palliativmedizin, Stuttgart; Heinrich Bodenstein and Hans-Joachim Tischler, Klinikum Minden, Klinik für Hämatologie und Onkologie, Minden; Reingard
| | - Malte von Bonin
- Christoph Röllig, Martin Bornhäuser, Christian Thiede, Franziska Taube, Michael Kramer, Brigitte Mohr, Ulrich Schuler, Friedrich Stölzel, Malte von Bonin, Markus Schaich, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden; Walter Aulitzky, Robert-Bosch-Krankenhaus Abteilung für Hämatologie, Onkologie und Palliativmedizin, Stuttgart; Heinrich Bodenstein and Hans-Joachim Tischler, Klinikum Minden, Klinik für Hämatologie und Onkologie, Minden; Reingard
| | - Hannes Wandt
- Christoph Röllig, Martin Bornhäuser, Christian Thiede, Franziska Taube, Michael Kramer, Brigitte Mohr, Ulrich Schuler, Friedrich Stölzel, Malte von Bonin, Markus Schaich, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden; Walter Aulitzky, Robert-Bosch-Krankenhaus Abteilung für Hämatologie, Onkologie und Palliativmedizin, Stuttgart; Heinrich Bodenstein and Hans-Joachim Tischler, Klinikum Minden, Klinik für Hämatologie und Onkologie, Minden; Reingard
| | - Kerstin Schäfer-Eckart
- Christoph Röllig, Martin Bornhäuser, Christian Thiede, Franziska Taube, Michael Kramer, Brigitte Mohr, Ulrich Schuler, Friedrich Stölzel, Malte von Bonin, Markus Schaich, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden; Walter Aulitzky, Robert-Bosch-Krankenhaus Abteilung für Hämatologie, Onkologie und Palliativmedizin, Stuttgart; Heinrich Bodenstein and Hans-Joachim Tischler, Klinikum Minden, Klinik für Hämatologie und Onkologie, Minden; Reingard
| | - Markus Schaich
- Christoph Röllig, Martin Bornhäuser, Christian Thiede, Franziska Taube, Michael Kramer, Brigitte Mohr, Ulrich Schuler, Friedrich Stölzel, Malte von Bonin, Markus Schaich, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden; Walter Aulitzky, Robert-Bosch-Krankenhaus Abteilung für Hämatologie, Onkologie und Palliativmedizin, Stuttgart; Heinrich Bodenstein and Hans-Joachim Tischler, Klinikum Minden, Klinik für Hämatologie und Onkologie, Minden; Reingard
| | - Gerhard Ehninger
- Christoph Röllig, Martin Bornhäuser, Christian Thiede, Franziska Taube, Michael Kramer, Brigitte Mohr, Ulrich Schuler, Friedrich Stölzel, Malte von Bonin, Markus Schaich, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden; Walter Aulitzky, Robert-Bosch-Krankenhaus Abteilung für Hämatologie, Onkologie und Palliativmedizin, Stuttgart; Heinrich Bodenstein and Hans-Joachim Tischler, Klinikum Minden, Klinik für Hämatologie und Onkologie, Minden; Reingard
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