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Al-Shaibani E, Novitzky-Basso I, Mattsson J, Kim DDH. Post-transplant maintenance therapy in acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation harmonizing multiple therapeutic modalities including targeted therapy, immunotherapy and cellular therapy. Int J Hematol 2023:10.1007/s12185-023-03614-x. [PMID: 37212948 DOI: 10.1007/s12185-023-03614-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/11/2023] [Accepted: 04/28/2023] [Indexed: 05/23/2023]
Abstract
Allogeneic hematopoietic stem cell transplant (HCT) has improved survival for patients with acute myeloid leukemia (AML), especially for those at high risk of relapse. However, relapse remains the leading cause of treatment failure post-HCT, occurring in around 35-45% of patients, and leading to dismal outcomes. Strategies to reduce relapse risk are urgently needed, especially in the early post-transplant period before activation of the graft-versus-leukemia (GVL) effect. Maintenance therapy is a course of treatment given post-HCT with the expectation of reducing relapse risk. While there are currently no therapies approved for maintenance therapy for AML after HCT, there are a number of studies and ongoing investigations examining the role of maintenance therapies that include targeted agents against FLT3-ITD, BCL2, or IDH mutations, hypomethylating agents, immunomodulatory therapies and cellular therapies. In this review, we discuss the mechanistic and clinical data for post-transplant maintenance therapies in AML and strategies for maintenance therapy for AML after HCT.
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Affiliation(s)
- Eshrak Al-Shaibani
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 610 University Ave, OPG Rm 6-222, Toronto, ON, Canada
| | - Igor Novitzky-Basso
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 610 University Ave, OPG Rm 6-222, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, M5G 2M9, Canada
| | - Jonas Mattsson
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 610 University Ave, OPG Rm 6-222, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, M5G 2M9, Canada
| | - Dennis Dong Hwan Kim
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 610 University Ave, OPG Rm 6-222, Toronto, ON, Canada.
- Department of Medicine, University of Toronto, Toronto, ON, M5G 2M9, Canada.
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Iannotta R, Celentano M, Marotta S, Pedata C, Riccardi C, Migliaccio I, Viola A, Muggianu S, Falco C, Bovenzi D, Ferrara F, Picardi A. Gilteritinib as treatment for extra-medullary relapse of FLT3-ITD acute myeloid leukemia FLT3-ITD, after allogeneic haematopoietic stem cell transplantation. Leuk Res Rep 2022; 18:100340. [PMID: 35958243 PMCID: PMC9358450 DOI: 10.1016/j.lrr.2022.100340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022] Open
Abstract
Case of a patient with acute myeloid leukemia (AML) positive for mutations in both genes NPM1 and FLT3-ITD who underwent two allogeneic haematopoietic stem cell transplants (HSCT); the second allograft one was followed by extramedullary relapse (granulocytic sarcoma of right breast), with blast cells positive for FLT3-ITDmutation. Treatment with Gilteritinib, a second generation selective oral type I FLT3 inhibitor, was started after the second HSCT with complete regression of breast granulocytic sarcoma in absence of hematological and extra hematologic toxicity. We conclude that Gilteritinib can represent an effective therapy for extra hematologic relapse, with acceptable toxicity and outpatient management.
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Affiliation(s)
- R. Iannotta
- Stem Cell Transplant Program, AORN Cardarelli, Naples, Italy
- Corresponding author.
| | - M. Celentano
- Stem Cell Transplant Program, AORN Cardarelli, Naples, Italy
| | - S. Marotta
- Stem Cell Transplant Program, AORN Cardarelli, Naples, Italy
| | - C.M. Pedata
- Stem Cell Transplant Program, AORN Cardarelli, Naples, Italy
| | - C. Riccardi
- Stem Cell Transplant Program, AORN Cardarelli, Naples, Italy
| | - I. Migliaccio
- Stem Cell Transplant Program, AORN Cardarelli, Naples, Italy
| | - A. Viola
- Hematology, AORN Cardarelli, Naples, Italy
| | - S.M. Muggianu
- Stem Cell Transplant Program, AORN Cardarelli, Naples, Italy
| | - C. Falco
- Transfusion Medicine Service, AORN Cardarelli, Naples, Italy
| | - D Bovenzi
- Transfusion Medicine Service, AORN Cardarelli, Naples, Italy
| | - F. Ferrara
- Hematology, AORN Cardarelli, Naples, Italy
| | - A. Picardi
- Stem Cell Transplant Program, AORN Cardarelli, Naples, Italy
- Dep. of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
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Aureli A, Marziani B, Sconocchia T, Del Principe MI, Buzzatti E, Pasqualone G, Venditti A, Sconocchia G. Immunotherapy as a Turning Point in the Treatment of Acute Myeloid Leukemia. Cancers (Basel) 2021; 13:cancers13246246. [PMID: 34944865 PMCID: PMC8699368 DOI: 10.3390/cancers13246246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/30/2021] [Accepted: 12/08/2021] [Indexed: 12/19/2022] Open
Abstract
Simple Summary Despite recent progress achieved in the management of acute myeloid leukemia (AML), it remains a life-threatening disease with a poor prognosis, particularly in the elderly, having an average 5-year survival of approximately 28%. However, recent evidence suggests that immunotherapy can provide the background for developing personalized targeted therapy to improve the clinical course of AML patients. Our review aimed to assess the immunotherapy effectiveness in AML by discussing the impact of monoclonal antibodies, immune checkpoint inhibitors, chimeric antigen receptor T cells, and vaccines in AML preclinical and clinical studies. Abstract Acute myeloid leukemia (AML) is a malignant disease of hematopoietic precursors at the earliest stage of maturation, resulting in a clonalproliferation of myoblasts replacing normal hematopoiesis. AML represents one of the most common types of leukemia, mostly affecting elderly patients. To date, standard chemotherapy protocols are only effective in patients at low risk of relapse and therapy-related mortality. The average 5-year overall survival (OS) is approximately 28%. Allogeneic hematopoietic stem cell transplantation (HSCT) improves prognosis but is limited by donor availability, a relatively young age of patients, and absence of significant comorbidities. Moreover, it is associated with significant morbidity and mortality. However, increasing understanding of AML immunobiology is leading to the development of innovative therapeutic strategies. Immunotherapy is considered an attractive strategy for controlling and eliminating the disease. It can be a real breakthrough in the treatment of leukemia, especially in patients who are not eligible forintensive chemotherapy. In this review, we focused on the progress of immunotherapy in the field of AML by discussing monoclonal antibodies (mAbs), immune checkpoint inhibitors, chimeric antigen receptor T cells (CAR-T cells), and vaccine therapeutic choices.
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Affiliation(s)
- Anna Aureli
- CNR Institute of Translational Pharmacology, 00133 Rome, Italy
- Correspondence: (A.A.); (G.S.)
| | - Beatrice Marziani
- Emergency and Urgent Department, University Hospital Sant’Anna of Ferrara, 44124 Ferrara, Italy;
| | | | - Maria Ilaria Del Principe
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy; (M.I.D.P.); (E.B.); (G.P.); (A.V.)
| | - Elisa Buzzatti
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy; (M.I.D.P.); (E.B.); (G.P.); (A.V.)
| | - Gianmario Pasqualone
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy; (M.I.D.P.); (E.B.); (G.P.); (A.V.)
| | - Adriano Venditti
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy; (M.I.D.P.); (E.B.); (G.P.); (A.V.)
| | - Giuseppe Sconocchia
- CNR Institute of Translational Pharmacology, 00133 Rome, Italy
- Correspondence: (A.A.); (G.S.)
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Bernasconi P, Borsani O. Eradication of Measurable Residual Disease in AML: A Challenging Clinical Goal. Cancers (Basel) 2021; 13:3170. [PMID: 34202000 PMCID: PMC8268140 DOI: 10.3390/cancers13133170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/15/2021] [Accepted: 06/19/2021] [Indexed: 12/18/2022] Open
Abstract
In non-promyelocytic (non-M3) AML measurable residual disease (MRD) detected by multi-parameter flow cytometry and molecular technologies, which are guided by Consensus-based guidelines and discover very low leukemic cell numbers far below the 5% threshold of morphological assessment, has emerged as the most relevant predictor of clinical outcome. Currently, it is well-established that MRD positivity after standard induction and consolidation chemotherapy, as well as during the period preceding an allogeneic hematopoietic stem cell transplant (allo-HSCT), portends to a significantly inferior relapse-free survival (RFS) and overall survival (OS). In addition, it has become absolutely clear that conversion from an MRD-positive to an MRD-negative state provides a favorable clinical outcome similar to that associated with early MRD negativity. Thus, the complete eradication of MRD, i.e., the clearance of the few leukemic stem cells-which, due to their chemo-radiotherapy resistance, might eventually be responsible of disease recurrence-has become an un-met clinical need in AML. Nowadays, this goal might potentially be achieved thanks to the development of novel innovative treatment strategies, including those targeting driver mutations, apoptosis, methylation patterns and leukemic proteins. The aim of this review is to analyze these strategies and to suggest any potential combination able to induce MRD negativity in the pre- and post-HSCT period.
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Affiliation(s)
- Paolo Bernasconi
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy;
- Hematology Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Oscar Borsani
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy;
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Buccisano F, Palmieri R, Piciocchi A, Maurillo L, Del Principe MI, Paterno G, Soddu S, Cerretti R, De Angelis G, Mariotti B, Irno Consalvo MA, Conti C, Fraboni D, Divona M, Ottone T, Lavorgna S, Panetta P, Voso MT, Arcese W, Venditti A. Use of Measurable Residual Disease to Evolve Transplant Policy in Acute Myeloid Leukemia: A 20-Year Monocentric Observation. Cancers (Basel) 2021; 13:1083. [PMID: 33802502 PMCID: PMC7959451 DOI: 10.3390/cancers13051083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/11/2021] [Accepted: 02/24/2021] [Indexed: 12/20/2022] Open
Abstract
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 post-consolidation 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.
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Affiliation(s)
- Francesco Buccisano
- Department of Biomedicine and Prevention, University Tor Vergata of Roma, 00133 Rome, Italy; (R.P.); (L.M.); (M.I.D.P.); (G.P.); (R.C.); (G.D.A.); (B.M.); (M.A.I.C.); (C.C.); (D.F.); (M.D.); (T.O.); (S.L.); (P.P.); (M.T.V.); (W.A.); (A.V.)
| | - Raffaele Palmieri
- Department of Biomedicine and Prevention, University Tor Vergata of Roma, 00133 Rome, Italy; (R.P.); (L.M.); (M.I.D.P.); (G.P.); (R.C.); (G.D.A.); (B.M.); (M.A.I.C.); (C.C.); (D.F.); (M.D.); (T.O.); (S.L.); (P.P.); (M.T.V.); (W.A.); (A.V.)
| | | | - Luca Maurillo
- Department of Biomedicine and Prevention, University Tor Vergata of Roma, 00133 Rome, Italy; (R.P.); (L.M.); (M.I.D.P.); (G.P.); (R.C.); (G.D.A.); (B.M.); (M.A.I.C.); (C.C.); (D.F.); (M.D.); (T.O.); (S.L.); (P.P.); (M.T.V.); (W.A.); (A.V.)
| | - Maria Ilaria Del Principe
- Department of Biomedicine and Prevention, University Tor Vergata of Roma, 00133 Rome, Italy; (R.P.); (L.M.); (M.I.D.P.); (G.P.); (R.C.); (G.D.A.); (B.M.); (M.A.I.C.); (C.C.); (D.F.); (M.D.); (T.O.); (S.L.); (P.P.); (M.T.V.); (W.A.); (A.V.)
| | - Giovangiacinto Paterno
- Department of Biomedicine and Prevention, University Tor Vergata of Roma, 00133 Rome, Italy; (R.P.); (L.M.); (M.I.D.P.); (G.P.); (R.C.); (G.D.A.); (B.M.); (M.A.I.C.); (C.C.); (D.F.); (M.D.); (T.O.); (S.L.); (P.P.); (M.T.V.); (W.A.); (A.V.)
| | - Stefano Soddu
- Centro Dati Fondazione GIMEMA, 00100 Rome, Italy; (A.P.); (S.S.)
| | - Raffaella Cerretti
- Department of Biomedicine and Prevention, University Tor Vergata of Roma, 00133 Rome, Italy; (R.P.); (L.M.); (M.I.D.P.); (G.P.); (R.C.); (G.D.A.); (B.M.); (M.A.I.C.); (C.C.); (D.F.); (M.D.); (T.O.); (S.L.); (P.P.); (M.T.V.); (W.A.); (A.V.)
- Rome Transplant Network, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Gottardo De Angelis
- Department of Biomedicine and Prevention, University Tor Vergata of Roma, 00133 Rome, Italy; (R.P.); (L.M.); (M.I.D.P.); (G.P.); (R.C.); (G.D.A.); (B.M.); (M.A.I.C.); (C.C.); (D.F.); (M.D.); (T.O.); (S.L.); (P.P.); (M.T.V.); (W.A.); (A.V.)
- Rome Transplant Network, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Benedetta Mariotti
- Department of Biomedicine and Prevention, University Tor Vergata of Roma, 00133 Rome, Italy; (R.P.); (L.M.); (M.I.D.P.); (G.P.); (R.C.); (G.D.A.); (B.M.); (M.A.I.C.); (C.C.); (D.F.); (M.D.); (T.O.); (S.L.); (P.P.); (M.T.V.); (W.A.); (A.V.)
- Rome Transplant Network, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Maria Antonietta Irno Consalvo
- Department of Biomedicine and Prevention, University Tor Vergata of Roma, 00133 Rome, Italy; (R.P.); (L.M.); (M.I.D.P.); (G.P.); (R.C.); (G.D.A.); (B.M.); (M.A.I.C.); (C.C.); (D.F.); (M.D.); (T.O.); (S.L.); (P.P.); (M.T.V.); (W.A.); (A.V.)
| | - Consuelo Conti
- Department of Biomedicine and Prevention, University Tor Vergata of Roma, 00133 Rome, Italy; (R.P.); (L.M.); (M.I.D.P.); (G.P.); (R.C.); (G.D.A.); (B.M.); (M.A.I.C.); (C.C.); (D.F.); (M.D.); (T.O.); (S.L.); (P.P.); (M.T.V.); (W.A.); (A.V.)
| | - Daniela Fraboni
- Department of Biomedicine and Prevention, University Tor Vergata of Roma, 00133 Rome, Italy; (R.P.); (L.M.); (M.I.D.P.); (G.P.); (R.C.); (G.D.A.); (B.M.); (M.A.I.C.); (C.C.); (D.F.); (M.D.); (T.O.); (S.L.); (P.P.); (M.T.V.); (W.A.); (A.V.)
| | - Mariadomenica Divona
- Department of Biomedicine and Prevention, University Tor Vergata of Roma, 00133 Rome, Italy; (R.P.); (L.M.); (M.I.D.P.); (G.P.); (R.C.); (G.D.A.); (B.M.); (M.A.I.C.); (C.C.); (D.F.); (M.D.); (T.O.); (S.L.); (P.P.); (M.T.V.); (W.A.); (A.V.)
| | - Tiziana Ottone
- Department of Biomedicine and Prevention, University Tor Vergata of Roma, 00133 Rome, Italy; (R.P.); (L.M.); (M.I.D.P.); (G.P.); (R.C.); (G.D.A.); (B.M.); (M.A.I.C.); (C.C.); (D.F.); (M.D.); (T.O.); (S.L.); (P.P.); (M.T.V.); (W.A.); (A.V.)
| | - Serena Lavorgna
- Department of Biomedicine and Prevention, University Tor Vergata of Roma, 00133 Rome, Italy; (R.P.); (L.M.); (M.I.D.P.); (G.P.); (R.C.); (G.D.A.); (B.M.); (M.A.I.C.); (C.C.); (D.F.); (M.D.); (T.O.); (S.L.); (P.P.); (M.T.V.); (W.A.); (A.V.)
| | - Paola Panetta
- Department of Biomedicine and Prevention, University Tor Vergata of Roma, 00133 Rome, Italy; (R.P.); (L.M.); (M.I.D.P.); (G.P.); (R.C.); (G.D.A.); (B.M.); (M.A.I.C.); (C.C.); (D.F.); (M.D.); (T.O.); (S.L.); (P.P.); (M.T.V.); (W.A.); (A.V.)
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, University Tor Vergata of Roma, 00133 Rome, Italy; (R.P.); (L.M.); (M.I.D.P.); (G.P.); (R.C.); (G.D.A.); (B.M.); (M.A.I.C.); (C.C.); (D.F.); (M.D.); (T.O.); (S.L.); (P.P.); (M.T.V.); (W.A.); (A.V.)
| | - William Arcese
- Department of Biomedicine and Prevention, University Tor Vergata of Roma, 00133 Rome, Italy; (R.P.); (L.M.); (M.I.D.P.); (G.P.); (R.C.); (G.D.A.); (B.M.); (M.A.I.C.); (C.C.); (D.F.); (M.D.); (T.O.); (S.L.); (P.P.); (M.T.V.); (W.A.); (A.V.)
- Rome Transplant Network, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Adriano Venditti
- Department of Biomedicine and Prevention, University Tor Vergata of Roma, 00133 Rome, Italy; (R.P.); (L.M.); (M.I.D.P.); (G.P.); (R.C.); (G.D.A.); (B.M.); (M.A.I.C.); (C.C.); (D.F.); (M.D.); (T.O.); (S.L.); (P.P.); (M.T.V.); (W.A.); (A.V.)
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6
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Craddock C, Jackson A, Loke J, Siddique S, Hodgkinson A, Mason J, Andrew G, Nagra S, Malladi R, Peniket A, Gilleece M, Salim R, Tholouli E, Potter V, Crawley C, Wheatley K, Protheroe R, Vyas P, Hunter A, Parker A, Wilson K, Pavlu J, Byrne J, Dillon R, Khan N, McCarthy N, Freeman SD. Augmented Reduced-Intensity Regimen Does Not Improve Postallogeneic Transplant Outcomes in Acute Myeloid Leukemia. J Clin Oncol 2021; 39:768-778. [PMID: 33373276 PMCID: PMC8078252 DOI: 10.1200/jco.20.02308] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/10/2020] [Accepted: 12/04/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Reduced-intensity conditioning (RIC) regimens have extended the curative potential of allogeneic stem-cell transplantation to older adults with high-risk acute myeloid leukemia (AML) and myelodysplasia (MDS) but are associated with a high risk of disease relapse. Strategies to reduce recurrence are urgently required. Registry data have demonstrated improved outcomes using a sequential transplant regimen, fludarabine/amsacrine/cytarabine-busulphan (FLAMSA-Bu), but the impact of this intensified conditioning regimen has not been studied in randomized trials. PATIENTS AND METHODS Two hundred forty-four patients (median age, 59 years) with high-risk AML (n = 164) or MDS (n = 80) were randomly assigned 1:1 to a fludarabine-based RIC regimen or FLAMSA-Bu. Pretransplant measurable residual disease (MRD) was monitored by flow cytometry (MFC-MRD) and correlated with outcome. RESULTS There was no difference in 2-year overall survival (hazard ratio 1.05 [85% CI, 0.80 to 1.38] P = .81) or cumulative incidence of relapse (CIR) (hazard ratio 0.94 [95%CI, 0.60 to 1.46] P = .81) between the control and FLAMSA-Bu arms. Detectable pretransplant MFC-MRD was associated with an increased CIR (2-year CIR 41.0% v 20.0%, P = .01) in the overall trial cohort with a comparable prognostic impact when measured by an unsupervised analysis approach. There was no evidence of interaction between MRD status and conditioning regimen intensity for relapse or survival. Acquisition of full donor T-cell chimerism at 3 months abrogated the adverse impact of pretransplant MRD on CIR and overall survival. CONCLUSION The intensified RIC conditioning regimen, FLAMSA-Bu, did not improve outcomes in adults transplanted for high-risk AML or MDS regardless of pretransplant MRD status. Our data instead support the exploration of interventions with the ability to accelerate acquisition of full donor T-cell chimerism as a tractable strategy to improve outcomes in patients allografted for AML.
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Affiliation(s)
- Charles Craddock
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | - Aimee Jackson
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | - Justin Loke
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Shamyla Siddique
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | - Andrea Hodgkinson
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | - John Mason
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | - Georgia Andrew
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - Sandeep Nagra
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Ram Malladi
- Addenbrookes Hospital, Cambridge, United Kingdom
| | | | | | | | | | | | | | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | | | | | - Ann Hunter
- Leicester Royal Infirmary, United Kingdom
| | - Anne Parker
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | | | - Jiri Pavlu
- Imperial College Hospital, London, Unite Kingdom
| | - Jenny Byrne
- Centre for Clinical Haematology, Nottingham, United Kingdom
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Naeem Khan
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - Nicholas McCarthy
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - Sylvie D. Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
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7
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Mannelli F, Gianfaldoni G, Bencini S, Piccini M, Cutini I, Bonetti MI, Scappini B, Pancani F, Ponziani V, Chiarini M, Borlenghi E, Bassan R, Rossi G, Bosi A. Early peripheral blast cell clearance predicts minimal residual disease status and refines disease prognosis in acute myeloid leukemia. Am J Hematol 2020; 95:1304-1313. [PMID: 32697337 DOI: 10.1002/ajh.25942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 12/17/2022]
Abstract
Minimal residual disease (MRD) assessment in acute myeloid leukemia (AML) is increasingly used in risk stratification. However, several issues around this use are unresolved, including, among others, the most suitable time-point(s) for its application. Overall, late assessments appear more effective at distinguishing outcome but, in some studies, the early evaluations were already highly informative, anticipating the value of later ones. Our work integrated MRD with peripheral blast clearance (PBC), a treatment-related biomarker previously demonstrated to be a powerful predictor of response. From 2007 to 2014, we have studied 120 patients treated according to the NILG 02-06 trial and who achieved CR after induction. Patients in PBC-defined categories (separated by a 1.5-log threshold) showed significantly different probabilities of attaining MRD negativity, after either induction (MRD1) or consolidation (MRD2). Peripheral blast clearance combined with MRD1 largely anticipated MRD2-related information: when both biomarkers predicted chemosensitive disease (PBChigh /MRD1neg ), the rate of MRD2-negativity was 90%, and DFS and OS estimates were 68% and 76% at 3 years, respectively. When both markers were unfavorable (PBClow /MRD1pos ), rates of MRD2 negativity, DFS, and OS were 20%, 34%, and 24%, respectively, at 3 years. In fact, MRD2 added prognostic value only in cases with discordant PBC/MRD1 data. Our data support a reasoned timing for MRD-based therapeutic decisions, modulated on individual chemosensitivity, an approach we have implemented in a forthcoming prospective multi-center trial by Gruppo Italiano Malattie EMatologiche dell'Adulto (GIMEMA).
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Affiliation(s)
- Francesco Mannelli
- SOD Ematologia Università di Firenze, AOU Careggi Florence Italy
- Centro Ricerca e Innovazione Malattie Mieloproliferative (CRIMM) AOU Careggi Florence Italy
| | | | - Sara Bencini
- SOD Ematologia Università di Firenze, AOU Careggi Florence Italy
- Centro Diagnostico di Citofluorimetria e Immunoterapia AOU Careggi Florence Italy
| | - Matteo Piccini
- SOD Ematologia Università di Firenze, AOU Careggi Florence Italy
| | - Ilaria Cutini
- SOD Ematologia Università di Firenze, AOU Careggi Florence Italy
- SOD Terapie Cellulari e Medicina Trasfusionale AOU Careggi Florence Italy
| | - Maria Ida Bonetti
- SOD Ematologia Università di Firenze, AOU Careggi Florence Italy
- Centro Diagnostico di Citofluorimetria e Immunoterapia AOU Careggi Florence Italy
| | - Barbara Scappini
- SOD Ematologia Università di Firenze, AOU Careggi Florence Italy
| | - Fabiana Pancani
- SOD Ematologia Università di Firenze, AOU Careggi Florence Italy
| | - Vanessa Ponziani
- SOD Ematologia Università di Firenze, AOU Careggi Florence Italy
| | - Marco Chiarini
- Centro di Ricerca Emato‐Oncologica AIL (CREA) Spedali Civili Brescia Italy
- Laboratorio di Citofluorimetria; Dipartimento di Diagnostica di Laboratorio Spedali Civili Brescia Italy
| | | | - Renato Bassan
- Unità Operativa di Ematologia Ospedale dell'Angelo Mestre ‐ Venezia Italy
| | | | - Alberto Bosi
- SOD Ematologia Università di Firenze, AOU Careggi Florence Italy
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8
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Shouval R, Labopin M, Bomze D, Baerlocher GM, Capria S, Blaise D, Hänel M, Forcade E, Huynh A, Saccardi R, Milone G, Zuckerman T, Reményi P, Versluis J, Esteve J, Gorin NC, Mohty M, Nagler A. Risk stratification using FLT3 and NPM1 in acute myeloid leukemia patients autografted in first complete remission. Bone Marrow Transplant 2020; 55:2244-2253. [PMID: 32388535 DOI: 10.1038/s41409-020-0936-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 11/09/2022]
Abstract
FLT3-ITD and NPM1 mutation refine prognostic stratification in acute myeloid leukemia (AML) with intermediate-risk cytogenetics. However, data on their role in patients undergoing autologous stem cell transplantation (Auto-SCT) as post-remission therapy (PRT) are limited. We therefore sought to retrospectively evaluate the role of FLT3-ITD and NPM1 in a cohort of AML patients (n = 405) with intermediate-risk cytogenetics, autografted in first complete remission (CR1). Patients were transplanted between 2000 and 2014 and reported to the European Society for Blood and Marrow Transplantation (EBMT) registry. Leukemia-free survival (LFS) was the primary outcome. Median follow-up was 5.5 years. FLT3-ITDneg/NPM1WT was the leading molecular subtype (50%), followed by FLT3-ITDneg/NPM1mut (30%). In the univariate analysis, molecular subtype was associated with LFS, overall survival (OS), and relapse incidence (RI) (p < 0.001); 5-year LFS: FLT3-ITDneg/NPM1mut 62%, FLT3-ITDpos/NPM1mut 38%, FLT3-ITDneg/NPM1WT 32%, and FLT3-ITDpos/NPM1WT 21%. At 5 years, OS and RI in the FLT3-ITDneg/NPM1mut subtype were 74% and 35%, respectively. The corresponding OS and RI in other subtypes were below 48% and over 57%. In a Cox multivariable model, molecular subtype was the strongest predictor of LFS, OS, and relapse. In conclusion, AML patients with intermediate-risk cytogenetics and FLT3-ITDneg/NPM1mut experience favorable outcomes when autografted in CR1, suggesting that Auto-SCT is a valid PRT option.
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Affiliation(s)
- Roni Shouval
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. .,Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
| | - Myriam Labopin
- Acute Leukemia Working Party of EBMT, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - David Bomze
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriela M Baerlocher
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Saveria Capria
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Didier Blaise
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - Mathias Hänel
- Department of Hematology, Oncology, Stem Cell Transplantation, Hospital Chemnitz, Chemnitz, Germany
| | - Edouard Forcade
- Hématologie Clinique et Thérapie cellulaire, CHU Bordeaux, Pessac, France
| | - Anne Huynh
- CHU Toulouse, IUCT-Oncopole, Toulouse, France
| | | | | | - Tsila Zuckerman
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Péter Reményi
- St. István and St. László Hospital of Budapest, Budapest, Hungary
| | - Jurjen Versluis
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Jordi Esteve
- Hematology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Mohamad Mohty
- Hospital Saint-Antoine, APHP, Sorbonne University, INSERM U938, Paris, France
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Acute Leukemia Working Party of EBMT, Paris, France
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9
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Venditti A, Gale RP, Buccisano F, Ossenkoppele G. Should persons with acute myeloid leukemia (AML) in 1st histological complete remission who are measurable residual disease (MRD) test positive receive an allotransplant? Leukemia 2020; 34:963-965. [PMID: 32132654 DOI: 10.1038/s41375-020-0780-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/01/2020] [Accepted: 02/18/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Adriano Venditti
- Department of Biomedicine and Prevention at University "Tor Vergata", Fondazione Policlinico Tor Vergata, Rome, Italy.
| | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Francesco Buccisano
- Department of Biomedicine and Prevention at University "Tor Vergata", Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Gert Ossenkoppele
- Department of Hematology, VU University Medical Centre Amsterdam, Amsterdam, Noord-Holland, The Netherlands
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10
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Cloos J, Ossenkoppele GJ, Dillon R. Minimal residual disease and stem cell transplantation outcomes. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:617-625. [PMID: 31808862 PMCID: PMC6913494 DOI: 10.1182/hematology.2019000006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Risk classification and tailoring of treatment are essential for improving outcome for patients with acute myeloid leukemia or high-risk myelodysplastic syndrome. Both patient and leukemia-specific characteristics assessed using morphology, cytogenetics, molecular biology, and multicolor flow cytometry are relevant at diagnosis and during induction, consolidation, and maintenance phases of the treatment. In particular, minimal residual disease (MRD) during therapy has potential as a prognostic factor of outcome, determination of response to therapy, and direction of targeted therapy. MRD can be determined by cell surface markers using multicolor flow cytometry, whereas leukemia-specific translocations and mutations are measured using polymerase chain reaction-based techniques and recently using next-generation sequencing. All these methods of MRD detection have their (dis)advantages, and all need to be standardized, prospectively validated, and improved to be used for uniform clinical decision making and a potential surrogate end point for clinical trials testing novel treatment strategies. Important issues to be solved are time point of MRD measurement and threshold for MRD positivity. MRD is used for stem cell transplantation (SCT) selection in the large subgroup of patients with an intermediate risk profile. Patients who are MRD positive will benefit from allo-SCT. However, MRD-negative patients have a better chance of survival after SCT. Therefore, it is debated whether MRD-positive patients should be extensively treated to become MRD negative before SCT. Either way, accurate monitoring of potential residual or upcoming disease is mandatory. Tailoring therapy according to MRD monitoring may be the most successful way to provide appropriate specifically targeted, personalized treatment.
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Affiliation(s)
- Jacqueline Cloos
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, VUMC, Amsterdam, The Netherlands; and
| | - Gert J Ossenkoppele
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, VUMC, Amsterdam, The Netherlands; and
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
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11
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Czyz A, Nagler A. The Role of Measurable Residual Disease (MRD) in Hematopoietic Stem Cell Transplantation for Hematological Malignancies Focusing on Acute Leukemia. Int J Mol Sci 2019; 20:ijms20215362. [PMID: 31661875 PMCID: PMC6862140 DOI: 10.3390/ijms20215362] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/21/2019] [Accepted: 10/23/2019] [Indexed: 01/17/2023] Open
Abstract
The significance of measurable residual disease (MRD) in hematopoietic stem cell transplantation (HSCT) is well recognized in different hematological malignancies, but the evidence indicate that pre-transplant MRD status is of particular importance in acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). In ALL, inadequate response at the level of MRD is a commonly accepted risk factor for relapse and thus an indication for allogeneic HSCT. Similarly, growing evidence from the literature strongly suggest that MRD detected by multiparameter flow cytometry or molecular techniques should be also used for risk stratification in AML at the time of HSCT. Despite the well-defined association of MRD and outcomes of HSCT in acute leukemias, there are still many open issues such as the role of additional pre-transplant consolidation for MRD eradication, the ability of HSCT to overcome negative influence of MRD positivity on survival, the impact of conditioning regimen intensity on MRD clearance post HSCT, and transplantation outcomes or the selection of optimal donor with regards to MRD status. In addition, the role of MRD assessment in guiding post-transplant maintenance treatment should also be addressed in prospective trials. These open issues mostly awaiting further clinical studies will be discussed in our current review.
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Affiliation(s)
- Anna Czyz
- Department of Hematology and Bone Marrow Transplantation, Wroclaw Medical University, Ludwik Pasteur 4, 50-367 Wroclaw, Poland.
| | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Derech Sheba 2, 52-621 Ramat Gan, Israel.
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12
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Next-generation sequencing-based minimal residual disease monitoring in patients receiving allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia or myelodysplastic syndrome. Curr Opin Hematol 2019; 25:425-432. [PMID: 30281033 DOI: 10.1097/moh.0000000000000464] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The monitoring of minimal residual disease (MRD) has important clinical implications in both the pre and postallogeneic stem cell transplant (SCT) setting in acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). Next-generation sequencing (NGS) is a rapidly improving technology whose application to the monitoring of MRD is an active area of research. We aim to describe existing methods of MRD in AML and MDS, with a focus on the utility of NGS in patients undergoing SCT. RECENT FINDINGS Flow cytometry and quantitative PCR have been recommended by the European Leukemia Net as the preferred methods of MRD in AML and MDS, but these methods have limitations in cases without a disease-defining phenotype and genotype. Clinical trials are currently ongoing to assess the use of NGS in the setting of SCT for MDS and AML. Few studies have so far assessed the optimal method of MRD monitoring in the posttransplant setting. SUMMARY The optimal method for the monitoring of MRD in AML and MDS both pre and post transplant may require more than one technology. NGS holds great promise for the monitoring of MRD, with prospective trials currently ongoing to evaluate its efficacy in this regard.
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13
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Schuurhuis GJ, Ossenkoppele GJ, Kelder A, Cloos J. Measurable residual disease in acute myeloid leukemia using flow cytometry: approaches for harmonization/standardization. Expert Rev Hematol 2019; 11:921-935. [PMID: 30466339 DOI: 10.1080/17474086.2018.1549479] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Measurable residual disease (MRD) in acute myeloid leukemia (AML) is a rapidly evolving area with many institutes embarking on it, both in academic and pharmaceutical settings. However, there is a multitude of approaches to design, perform, and report flow cytometric MRD. Together with the long-term experience needed, this makes flow cytometric MRD in AML nonstandardized and time-consuming. Areas covered: This paper briefly summarizes critical issues, like sample preparation and transport, markers and fluorochromes of choice, but in particular focuses on the main issues, which includes specificity and sensitivity, hereby providing a new model that may circumvent the main disadvantages of the present approaches. New approaches that may add to the value of flow cytometric MRD includes assessment of leukemia stem cells, MRD in peripheral blood, and approaches to use multidimensional image analysis. Expert commentary: MRD in AML requires standardization/harmonization on many aspects, for which the present paper offers possible guidelines.
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Affiliation(s)
- Gerrit J Schuurhuis
- a Department of Hematology , VU University Medical Center , Amsterdam , Netherlands
| | - Gert J Ossenkoppele
- a Department of Hematology , VU University Medical Center , Amsterdam , Netherlands
| | - Angèle Kelder
- a Department of Hematology , VU University Medical Center , Amsterdam , Netherlands
| | - Jacqueline Cloos
- a Department of Hematology , VU University Medical Center , Amsterdam , Netherlands
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14
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GIMEMA AML1310 trial of risk-adapted, MRD-directed therapy for young adults with newly diagnosed acute myeloid leukemia. Blood 2019; 134:935-945. [DOI: 10.1182/blood.2018886960] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 08/01/2019] [Indexed: 12/11/2022] Open
Abstract
Key Points
A risk-adapted, MRD-driven transplant strategy is a feasible approach for the treatment of younger adults with AML. Pretransplant MRD positivity should not contraindicate delivery of an allogeneic stem cell transplant.
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15
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Versluis J, Cornelissen JJ. Risks and benefits in a personalized application of allogeneic transplantation in patients with AML in first CR. Semin Hematol 2019; 56:164-170. [DOI: 10.1053/j.seminhematol.2018.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/29/2018] [Accepted: 08/29/2018] [Indexed: 11/11/2022]
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16
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Ehinger M, Pettersson L. Measurable residual disease testing for personalized treatment of acute myeloid leukemia. APMIS 2019; 127:337-351. [PMID: 30919505 DOI: 10.1111/apm.12926] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/28/2018] [Indexed: 12/13/2022]
Abstract
This review summarizes - with the practicing hematologist in mind - the methods used to determine measurable residual disease (MRD) in everyday practice with some future perspectives, and the current knowledge about the prognostic impact of MRD on outcome in acute myeloid leukemia (AML), excluding acute promyelocytic leukemia. Possible implications for choice of MRD method, timing of MRD monitoring, and guidance of therapy are discussed in general and in some detail for certain types of leukemia with specific molecular markers to monitor, including core binding factor (CBF)-leukemias and NPM1-mutated leukemias.
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Affiliation(s)
- Mats Ehinger
- Department of Clinical Sciences, Pathology, Skane University Hospital, Lund University, Lund, Sweden
| | - Louise Pettersson
- Department of Pathology, Halland Hospital Halmstad, Region Halland, Halmstad, Sweden.,Faculty of Medicine, Division of Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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17
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Buccisano F, Maurillo L, Schuurhuis GJ, Del Principe MI, Di Veroli A, Gurnari C, Venditti A. The emerging role of measurable residual disease detection in AML in morphologic remission. Semin Hematol 2018; 56:125-130. [PMID: 30926088 DOI: 10.1053/j.seminhematol.2018.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/03/2018] [Accepted: 09/14/2018] [Indexed: 01/08/2023]
Abstract
Despite the increasing knowledge of the genomic landscape of acute myeloid leukemia (AML), prediction merely based on genetics fails to anticipate outcome, presumably due to the heterogeneous composition of the leukemic clone determining complex interactions between different genetic abnormalities. Therefore, the introduction of a post-treatment biomarker exploring the quality of response to therapy such as assessment of measurable (previously minimal) residual disease (MRD) may lead to refinements of the prognostic assessment in AML. In this view, the European LeukemiaNet has recently endorsed the achievement of a MRD negative morphologic complete remission as a purpose the treatment. Techniques like multiparametric flow cytometry and reverse transcriptase-quantitative polymerase chain reaction have reached a level of sensitivity and specificity that make them ready for introduction in clinical practice. In the present review, we will give an update on the efforts in harmonization and/or standardization of MRD assessment in AML, focusing on the newest acquisitions in the clinical applications of MRD, and considering issues like relationship of MRD with leukemic stem cells or MRD assessment in peripheral blood.
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Affiliation(s)
- F Buccisano
- Hematology Unit, Department of Biomedicine and Prevention, University tor Vergata of Rome, Rome, Italy.
| | - L Maurillo
- Hematology Unit, Department of Biomedicine and Prevention, University tor Vergata of Rome, Rome, Italy
| | - G J Schuurhuis
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - M I Del Principe
- Hematology Unit, Department of Biomedicine and Prevention, University tor Vergata of Rome, Rome, Italy
| | - A Di Veroli
- Hematology Unit, Department of Biomedicine and Prevention, University tor Vergata of Rome, Rome, Italy
| | - C Gurnari
- Hematology Unit, Department of Biomedicine and Prevention, University tor Vergata of Rome, Rome, Italy
| | - A Venditti
- Hematology Unit, Department of Biomedicine and Prevention, University tor Vergata of Rome, Rome, Italy
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18
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Buccisano F, Maurillo L, Del Principe MI, Di Veroli A, De Bellis E, Biagi A, Zizzari A, Rossi V, Rapisarda V, Amadori S, Voso MT, Lo-Coco F, Arcese W, Venditti A. Minimal residual disease as a biomarker for outcome prediction and therapy optimization in acute myeloid leukemia. Expert Rev Hematol 2018; 11:307-313. [PMID: 29495904 DOI: 10.1080/17474086.2018.1447378] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Response to therapy is affected by the genetic heterogeneity of acute myeloid leukemia (AML) and persistence of leukemic cells below the threshold of morphological complete remission (mCR). Such persistence is called minimal (or measurable) residual disease (MRD). Areas covered: MRD assessment allows early identification of patients who are at high risk of relapse and who should timely receive aggressive therapy (e.g. allogeneic stem cell transplantation) and of those with a good quality mCR in whom an aggressive front-line therapy can be spared, avoiding the harm of excessive treatment toxicity. The most exploited methods to assess MRD are multiparameter flow cytometry (via identification of immunophenotypic aberrancies) or PCR-based assays (via identification of cytogenetic/molecular abnormalities). Expert commentary: A growing body of evidences demonstrates that positive MRD-testing at various time-points throughout the treatment course identifies patients at high risk of relapse. We will focus on the role of MRD as a biomarker to refine risk assessment and to prospectively direct treatment choices in adult with AML.
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Affiliation(s)
- Francesco Buccisano
- a Department of Biomedicine and Prevention , University Tor Vergata of Rome , Rome , Italy
| | - Luca Maurillo
- a Department of Biomedicine and Prevention , University Tor Vergata of Rome , Rome , Italy
| | | | - Ambra Di Veroli
- a Department of Biomedicine and Prevention , University Tor Vergata of Rome , Rome , Italy
| | - Eleonora De Bellis
- a Department of Biomedicine and Prevention , University Tor Vergata of Rome , Rome , Italy
| | - Annalisa Biagi
- a Department of Biomedicine and Prevention , University Tor Vergata of Rome , Rome , Italy
| | - Annagiulia Zizzari
- a Department of Biomedicine and Prevention , University Tor Vergata of Rome , Rome , Italy
| | - Valentina Rossi
- a Department of Biomedicine and Prevention , University Tor Vergata of Rome , Rome , Italy
| | - Vito Rapisarda
- a Department of Biomedicine and Prevention , University Tor Vergata of Rome , Rome , Italy
| | - Sergio Amadori
- a Department of Biomedicine and Prevention , University Tor Vergata of Rome , Rome , Italy
| | - Maria Teresa Voso
- a Department of Biomedicine and Prevention , University Tor Vergata of Rome , Rome , Italy
| | - Francesco Lo-Coco
- a Department of Biomedicine and Prevention , University Tor Vergata of Rome , Rome , Italy
| | - William Arcese
- a Department of Biomedicine and Prevention , University Tor Vergata of Rome , Rome , Italy
| | - Adriano Venditti
- a Department of Biomedicine and Prevention , University Tor Vergata of Rome , Rome , Italy
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19
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Versluis J, Kalin B, Zeijlemaker W, Passweg J, Graux C, Manz MG, Vekemans MC, Biemond BJ, Legdeur MCJ, Kooy MVM, de Weerdt O, Wijermans PW, Hoogendoorn M, Bargetzi MJ, Kuball J, Schouten HC, van der Velden VH, Janssen JJ, Pabst T, Lowenberg B, Jongen-Lavrencic M, Schuurhuis GJ, Ossenkoppele G, Cornelissen JJ. Graft-Versus-Leukemia Effect of Allogeneic Stem-Cell Transplantation and Minimal Residual Disease in Patients With Acute Myeloid Leukemia in First Complete Remission. JCO Precis Oncol 2017; 1:1-13. [DOI: 10.1200/po.17.00078] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose The detection of minimal residual disease (MRD) in patients with acute myeloid leukemia (AML) may improve future risk-adapted treatment strategies. We assessed whether MRD-positive and MRD-negative patients with AML benefit differently from the graft-versus-leukemia effect of allogeneic hematopoietic stem-cell transplantation (alloHSCT). Methods A total of 1,511 patients were treated in subsequent Dutch-Belgian Hemato-Oncology Cooperative Group and the Swiss Group for Clinical Cancer Research AML trials, of whom 547 obtained a first complete remission, received postremission treatment (PRT), and had available flow cytometric MRD before PRT. MRD positivity was defined as more than 0.1% cells with a leukemia-associated immunophenotype within the WBC compartment. PRT consisted of alloHSCT (n = 282), conventional PRT by a third cycle of chemotherapy (n = 160), or autologous hematopoietic stem-cell transplantation (n = 105). Results MRD was positive in 129 patients (24%) after induction chemotherapy before proceeding to PRT. Overall survival and relapse-free survival were significantly better in patients without MRD before PRT compared with MRD-positive patients (65% ± 2% v 50% ± 5% at 4 years; P = .002; and 58% ± 3% v 38% ± 4%; P < .001, respectively), which was mainly because of a lower cumulative incidence of relapse (32% ± 2% compared with 54% ± 4%; P < .001, respectively). Multivariable analysis with adjustment for covariables showed that the incidence of relapse was significantly reduced after alloHSCT compared with chemotherapy or autologous hematopoietic stem cell transplantation (hazard ratio [HR], 0.36; P < .001), which was similarly exerted in both MRD-negative and MRD-positive patients (HR, 0.38; P < .001; and HR, 0.35; P < .001, respectively). Conclusion The graft-versus-leukemia effect of alloHSCT is equally present in MRD-positive and MRD-negative patients, which advocates a personalized application of alloHSCT, taking into account the risk of relapse determined by AML risk group and MRD status, as well as the counterbalancing risk of nonrelapse mortality.
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Affiliation(s)
- Jurjen Versluis
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Burak Kalin
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Wendelien Zeijlemaker
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Jakob Passweg
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Carlos Graux
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Markus G. Manz
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Marie-Christiane Vekemans
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Bart J. Biemond
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Marie-Cecile J.C. Legdeur
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Marinus van Marwijk Kooy
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Okke de Weerdt
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Pierre W. Wijermans
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Mels Hoogendoorn
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Mario J. Bargetzi
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Juergen Kuball
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Harry C. Schouten
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Vincent H.J. van der Velden
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Jeroen J.W.M. Janssen
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Thomas Pabst
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Bob Lowenberg
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Mojca Jongen-Lavrencic
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Gerrit Jan Schuurhuis
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Gert Ossenkoppele
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Jan J. Cornelissen
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
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