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Lucero J, Alhumaid M, Novitzky-Basso I, Capo-Chichi JM, Stockley T, Gupta V, Bankar A, Chan S, Schuh AC, Minden M, Mattsson J, Kumar R, Sibai H, Tierens A, Kim DDH. Flow cytometry-based measurable residual disease (MRD) analysis identifies AML patients who may benefit from allogeneic hematopoietic stem cell transplantation. Ann Hematol 2024; 103:1187-1196. [PMID: 38291275 DOI: 10.1007/s00277-024-05639-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/21/2024] [Indexed: 02/01/2024]
Abstract
Measurable residual disease (MRD) monitoring independently predicts long-term outcomes in patients with acute myeloid leukemia (AML). Of the various modalities available, multiparameter flow cytometry-based MRD analysis is widely used and relevant for patients without molecular targets. In the transplant (HCT) setting, the presence of MRD pre-HCT is associated with adverse outcomes. MRD-negative remission status pre-HCT was also associated with longer overall (OS) and progression-free survival and a lower risk of relapse. We hypothesize that the combination of disease risk and MRD at the time of first complete remission (CR1) could identify patients according to the benefit gained from HCT, especially for intermediate-risk patients. We performed a retrospective analysis comparing the outcomes of HCT versus non-HCT therapies based on MRD status in AML patients who achieved CR1. Time-dependent analysis was applied considering time-to-HCT as a time-dependent covariate and compared HCT versus non-HCT outcomes according to MRD status at CR1. Among 336 patients assessed at CR1, 35.1% were MRD positive (MRDpos) post-induction. MRDpos patients benefitted from HCT with improved OS and relapse-free survival (RFS), while no benefit was observed in MRDneg patients. In adverse-risk patients, HCT improved OS (HR for OS 0.55; p = 0.05). In intermediate-risk patients, HCT benefit was not significant for OS and RFS. Intermediate-risk MRDpos patients were found to have benefit from HCT with improved OS (HR 0.45, p = 0.04), RFS (HR 0.46, p = 0.02), and CIR (HR 0.41, p = 0.02). Our data underscore the benefit of HCT in adverse risk and MRDpos intermediate-risk AML patients.
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Affiliation(s)
- Josephine Lucero
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
| | | | - Igor Novitzky-Basso
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jose-Mario Capo-Chichi
- Advanced Molecular Diagnostics Laboratory, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Tracy Stockley
- Division of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Vikas Gupta
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Aniket Bankar
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Steven Chan
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Andre C Schuh
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Mark Minden
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jonas Mattsson
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Rajat Kumar
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Hassan Sibai
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Anne Tierens
- Division of Hematology and Transfusion Medicine, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Dennis D H Kim
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
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2
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Murphy T, Zou J, Arruda A, Wang TT, Zhao Z, Zheng Y, Gupta V, Maze D, McNamara C, Minden MD, Schimmer A, Sibai H, Yee K, Capo-Chichi JM, Stockley T, Schuh A, Bratman SV, Chan SM. Exclusion of persistent mutations in splicing factor genes and isocitrate dehydrogenase 2 improves the prognostic power of molecular measurable residual disease assessment in acute myeloid leukemia. Haematologica 2024; 109:671-675. [PMID: 37345484 PMCID: PMC10828788 DOI: 10.3324/haematol.2023.283510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/14/2023] [Indexed: 06/23/2023] Open
Affiliation(s)
- Tracy Murphy
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario
| | - Jinfeng Zou
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario
| | - Andrea Arruda
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario
| | - Ting Ting Wang
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario
| | - Zhen Zhao
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario
| | - Yangqiao Zheng
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario
| | - Vikas Gupta
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario
| | - Dawn Maze
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario
| | | | - Mark D Minden
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario
| | - Aaron Schimmer
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario
| | - Hassan Sibai
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario
| | - Karen Yee
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario
| | - Jose-Mario Capo-Chichi
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada; Laboratory Medicine Program, University Health Network, Toronto, ON
| | - Tracy Stockley
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada; Laboratory Medicine Program, University Health Network, Toronto, ON
| | - Andre Schuh
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario
| | - Scott V Bratman
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario
| | - Steven M Chan
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario.
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Wong ZC, Dillon LW, Hourigan CS. Measurable residual disease in patients undergoing allogeneic transplant for acute myeloid leukemia. Best Pract Res Clin Haematol 2023; 36:101468. [PMID: 37353292 PMCID: PMC10291441 DOI: 10.1016/j.beha.2023.101468] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/11/2023] [Indexed: 06/25/2023]
Abstract
The most common indication for allogeneic hematopoietic cell transplant (alloHCT) is maintenance of remission after initial treatment for patients with acute myeloid leukemia (AML). Loss of remission, relapse, remains however the most frequent cause of alloHCT failure. There is strong evidence that detectable persistent disease burden ("measurable residual disease", MRD) in patients with AML in remission prior to alloHCT is associated with increased risk of post-transplant relapse. MRD status as a summative assessment of response to pre-transplant therapy may allow superior patient-personalized risk stratification compared with models solely incorporating pre-treatment variables. An optimal methodology for AML MRD detection has not yet been established, but molecular methods such as DNA-sequencing may have additional prognostic utility compared to current approaches. There is growing evidence that intervention on AML MRD positivity may improve post-transplant outcomes. New initiatives will generate actionable data on the clinical utility of AML MRD testing for patients undergoing alloHCT.
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Affiliation(s)
- Zoë C Wong
- Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA; Myeloid Malignancies Program, National Institutes of Health, Bethesda, MD, USA
| | - Laura W Dillon
- Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA; Myeloid Malignancies Program, National Institutes of Health, Bethesda, MD, USA
| | - Christopher S Hourigan
- Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA; Myeloid Malignancies Program, National Institutes of Health, Bethesda, MD, USA.
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Measurable Residual Disease and Clonal Evolution in Acute Myeloid Leukemia from Diagnosis to Post-Transplant Follow-Up: The Role of Next-Generation Sequencing. Biomedicines 2023; 11:biomedicines11020359. [PMID: 36830896 PMCID: PMC9953407 DOI: 10.3390/biomedicines11020359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
It has now been ascertained that acute myeloid leukemias-as in most type of cancers-are mixtures of various subclones, evolving by acquiring additional somatic mutations over the course of the disease. The complexity of leukemia clone architecture and the phenotypic and/or genotypic drifts that can occur during treatment explain why more than 50% of patients-in hematological remission-could relapse. Moreover, the complexity and heterogeneity of clone architecture represent a hindrance for monitoring measurable residual disease, as not all minimal residual disease monitoring methods are able to detect genetic mutations arising during treatment. Unlike with chemotherapy, which imparts a relatively short duration of selective pressure on acute myeloid leukemia clonal architecture, the immunological effect related to allogeneic hematopoietic stem cell transplant is prolonged over time and must be overcome for relapse to occur. This means that not all molecular abnormalities detected after transplant always imply inevitable relapse. Therefore, transplant represents a critical setting where a measurable residual disease-based strategy, performed during post-transplant follow-up by highly sensitive methods such as next-generation sequencing, could optimize and improve treatment outcome. The purpose of our review is to provide an overview of the role of next-generation sequencing in monitoring both measurable residual disease and clonal evolution in acute myeloid leukemia patients during the entire course of the disease, with special focus on the transplant phase.
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Ahn J, Kim T, Jung S, Ahn S, Song G, Kim M, Yang D, Lee J, Kim MY, Moon JH, Zhang Z, Kim H, Kim DDH. Next-generation sequencing-based analysis to assess the pattern of relapse in patients with Philadelphia-positive acute lymphoblastic leukemia. EJHAEM 2022; 3:1145-1153. [PMID: 36467841 PMCID: PMC9713221 DOI: 10.1002/jha2.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 06/17/2023]
Abstract
In this study, we performed serial monitoring using targeted DNA sequencing to identify genetic alterations in adults with Philadelphia-positive acute lymphoblastic leukemia (Ph-ALL). Deep sequencing was performed by targeting the coding regions of 45 genes with recurrent driver mutations and 1129 single nucleotide polymorphism sites. Of the 43 patients that we examined, at least one case of genetic alterations was detected in 38 (88%) of the 43 patients at diagnosis (somatic mutations in 10 patients [23%] and copy number aberrations [CNA] in 36 patients [84%]). The most frequently detected CNA lesions were in IKZF1 (n = 25, 58%) and the most frequently mutated gene was SETD2 (n = 5). At least one genetic abnormality (loss, gain, or persistence) was observed in all the samples obtained at relapse that were available for analysis (n = 15), compared with the samples obtained at diagnosis (disappearance of any previously detected genetic alterations: 11 patients [73%]; new genetic abnormalities: nine patients [60%]; and persistent genetic abnormalities: eight patients [53%]]. The most frequently deleted lesions were in IKZF1 (n = 9, 60%), and the most frequently mutated gene was ABL1 (eight patients, 53%). Our data indicate that leukemic progression may be associated with complex genetic alterations in Ph-ALL during the course of treatment.
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Affiliation(s)
- Jae‐Sook Ahn
- Department of Internal Medicine, Chonnam National University Hwasun HospitalChonnam National UniversityGwangjuRepublic of Korea
- Genomic Research Center for Hematopoietic DiseasesChonnam National University Hwasun HospitalJeollanam‐doRepublic of Korea
| | - TaeHyung Kim
- The Donnelly Centre for Cellular and Biomolecular ResearchUniversity of TorontoTorontoOntarioCanada
- Department of Computer ScienceUniversity of TorontoTorontoOntarioCanada
| | - Sung‐Hoon Jung
- Department of Internal Medicine, Chonnam National University Hwasun HospitalChonnam National UniversityGwangjuRepublic of Korea
| | - Seo‐Yeon Ahn
- Department of Internal Medicine, Chonnam National University Hwasun HospitalChonnam National UniversityGwangjuRepublic of Korea
| | - Ga‐Young Song
- Department of Internal Medicine, Chonnam National University Hwasun HospitalChonnam National UniversityGwangjuRepublic of Korea
| | - Mihee Kim
- Department of Internal Medicine, Chonnam National University Hwasun HospitalChonnam National UniversityGwangjuRepublic of Korea
| | - Deok‐Hwan Yang
- Department of Internal Medicine, Chonnam National University Hwasun HospitalChonnam National UniversityGwangjuRepublic of Korea
| | - Je‐Jung Lee
- Department of Internal Medicine, Chonnam National University Hwasun HospitalChonnam National UniversityGwangjuRepublic of Korea
| | - Mi Yeon Kim
- Genomic Research Center for Hematopoietic DiseasesChonnam National University Hwasun HospitalJeollanam‐doRepublic of Korea
| | - Joon Ho Moon
- Department of Hematology‐OncologyKyungpook National University Hospital, School of Medicine, Kyungpook National UniversityDaeguRepublic of Korea
| | - Zhaolei Zhang
- The Donnelly Centre for Cellular and Biomolecular ResearchUniversity of TorontoTorontoOntarioCanada
- Department of Computer ScienceUniversity of TorontoTorontoOntarioCanada
- Department of Medical Oncology and Hematology, Princess Margaret Cancer CentreUniversity of TorontoTorontoOntarioCanada
| | - Hyeoung‐Joon Kim
- Department of Internal Medicine, Chonnam National University Hwasun HospitalChonnam National UniversityGwangjuRepublic of Korea
- Genomic Research Center for Hematopoietic DiseasesChonnam National University Hwasun HospitalJeollanam‐doRepublic of Korea
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Qin D. Molecular testing for acute myeloid leukemia. Cancer Biol Med 2021; 19:j.issn.2095-3941.2020.0734. [PMID: 34347394 PMCID: PMC8763005 DOI: 10.20892/j.issn.2095-3941.2020.0734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/02/2021] [Indexed: 11/11/2022] Open
Abstract
In the era of personalized medicine, information on molecular change at the gene level is important for patient care. Such information has been used for disease classification, diagnosis, prognosis, risk stratification, and treatment, which is especially important in cancer patient care. Many molecular tests exist and can be used to detect the molecular changes at gene level. These tests include, but are not limited to, karyotyping, endpoint polymerase chain reaction (PCR), real-time PCR, Sanger sequencing, pyrosequencing, next-generation sequencing, and so forth. How to use the right tests for the right patients at the right time is essential for optimal patient outcome. This review puts together some information on molecular testing for acute myeloid leukemia.
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Affiliation(s)
- Dahui Qin
- Moffitt Cancer Center, Tampa, FL 33612-9416, USA
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