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Döhner H, Wei AH, Roboz GJ, Montesinos P, Thol FR, Ravandi F, Dombret H, Porkka K, Sandhu I, Skikne B, See WL, Ugidos M, Risueño A, Chan ET, Thakurta A, Beach CL, Lopes de Menezes D. Prognostic impact of NPM1 and FLT3 mutations in patients with AML in first remission treated with oral azacitidine. Blood 2022; 140:1674-1685. [PMID: 35960871 PMCID: PMC10653004 DOI: 10.1182/blood.2022016293] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/27/2022] [Indexed: 11/20/2022] Open
Abstract
The randomized, placebo-controlled, phase 3 QUAZAR AML-001 trial (ClinicalTrials.gov identifier: NCT01757535) evaluated oral azacitidine (Oral-AZA) in patients with acute myeloid leukemia (AML) in first remission after intensive chemotherapy (IC) who were not candidates for hematopoietic stem cell transplantation. Eligible patients were randomized 1:1 to Oral-AZA 300 mg or placebo for 14 days per 28-day cycle. We evaluated relapse-free survival (RFS) and overall survival (OS) in patient subgroups defined by NPM1 and FLT3 mutational status at AML diagnosis and whether survival outcomes in these subgroups were influenced by presence of post-IC measurable residual disease (MRD). Gene mutations at diagnosis were collected from patient case report forms; MRD was determined centrally by multiparameter flow cytometry. Overall, 469 of 472 randomized patients (99.4%) had available mutational data; 137 patients (29.2%) had NPM1 mutations (NPM1mut), 66 patients (14.1%) had FLT3 mutations (FLT3mut; with internal tandem duplications [ITD], tyrosine kinase domain mutations [TKDmut], or both), and 30 patients (6.4%) had NPM1mut and FLT3-ITD at diagnosis. Among patients with NPM1mut, OS and RFS were improved with Oral-AZA by 37% (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.41-0.98) and 45% (HR, 0.55; 95% CI, 0.35-0.84), respectively, vs placebo. Median OS was improved numerically with Oral-AZA among patients with NPM1mut whether without MRD (48.6 months vs 31.4 months with placebo) or with MRD (46.1 months vs 10.0 months with placebo) post-IC. Among patients with FLT3mut, Oral-AZA improved OS and RFS by 37% (HR, 0.63; 95% CI, 0.35-1.12) and 49% (HR, 0.51; 95% CI, 0.27-0.95), respectively, vs placebo. Median OS with Oral-AZA vs placebo was 28.2 months vs 16.2 months, respectively, for patients with FLT3mut and without MRD and 24.0 months vs 8.0 months for patients with FLT3mut and MRD. In multivariate analyses, Oral-AZA significantly improved survival independent of NPM1 or FLT3 mutational status, cytogenetic risk, or post-IC MRD status.
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Affiliation(s)
- Hartmut Döhner
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | - Andrew H Wei
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, Australia
| | - Gail J Roboz
- Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
- Division of Hematology & Medical Oncology, New York Presbyterian Hospital, New York, NY
| | - Pau Montesinos
- Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Felicitas R Thol
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Medizinische Hochschule Hannover, Hannover, Germany
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hervé Dombret
- Leukemia Unit, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Institut de Recherche Saint Louis, Université de Paris, Paris, France
| | - Kimmo Porkka
- Hematology Research Unit Helsinki, HUS Comprehensive Cancer Center, and iCAN Digital Precision Cancer Center Medicine Flagship, University of Helsinki, Helsinki, Finland
| | - Irwindeep Sandhu
- Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Barry Skikne
- University of Kansas Medical Center, Kansas City, KS
- Bristol Myers Squibb, Princeton, NJ
| | - Wendy L See
- Translational Medicine, Bristol Myers Squibb, Summit, NJ
| | - Manuel Ugidos
- BMS Center for Innovation and Translational Research Europe (CITRE), a Bristol-Myers Squibb Company, Seville, Spain
| | - Alberto Risueño
- BMS Center for Innovation and Translational Research Europe (CITRE), a Bristol-Myers Squibb Company, Seville, Spain
| | | | - Anjan Thakurta
- Translational Medicine, Bristol Myers Squibb, Summit, NJ
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Oral azacitidine prolongs survival of patients with AML in remission independent of measurable residual disease status. Blood 2022; 139:2145-2155. [PMID: 34995344 DOI: 10.1182/blood.2021013404] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/29/2021] [Indexed: 11/20/2022] Open
Abstract
Measurable residual disease (MRD) in patients with acute myeloid leukemia (AML) in remission after intensive chemotherapy is predictive of early relapse and poor survival. Post-remission maintenance therapy that prolongs MRD negativity or converts MRD positive (MRD+) patients to MRD negative (MRD-) status may delay or prevent relapse and improve overall survival (OS). In the phase 3 QUAZAR AML-001 trial, oral azacitidine (Oral-AZA; formerly CC-486), a hypomethylating agent, significantly prolonged OS and relapse-free survival (RFS) compared with placebo in patients aged ≥55 years with AML in first remission after intensive chemotherapy who were not candidates for hematopoietic stem cell transplantation. In this trial, MRD (≥0.1% leukemic cells in bone marrow) was assessed by multiparameter flow cytometry in serial samples collected at baseline and on day 1 of every 3 cycles. As expected, baseline MRD status was significantly associated with both OS and RFS. Multivariate analyses showed Oral-AZA significantly improved OS and RFS vs. placebo independent of baseline MRD status. Oral-AZA treatment also extended the duration of MRD negativity by 6 months vs. placebo, and resulted in a higher rate of conversion from MRD+ at baseline to MRD- during treatment: 37% vs. 19%, respectively. In the Oral-AZA arm, 24% of MRD responders achieved MRD negativity >6 months after treatment initiation. While presence or absence of MRD was a strong prognostic indicator of OS and RFS, there were added survival benefits with Oral-AZA maintenance therapy compared with placebo, independent of patients' MRD status at baseline. NCT01757535 Clinicaltrials.gov.
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Ghannam J, Dillon LW, Hourigan CS. Next-generation sequencing for measurable residual disease detection in acute myeloid leukaemia. Br J Haematol 2019; 188:77-85. [PMID: 31804716 DOI: 10.1111/bjh.16362] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acute myeloid leukaemia (AML) is a blood cancer characterized by acquired genetic mutations. There is great interest in accurately establishing measurable residual disease (MRD) burden in AML patients in remission after treatment but at risk of relapse. However, inter- and intrapatient genetic diversity means that, unlike in the chronic myeloid and acute promyelocytic leukaemias, no single genetic abnormality is pathognomonic for all cases of AML MRD. Next-generation sequencing offers the opportunity to test broadly and deeply for potential genetic evidence of residual AML, and while not currently accepted for such use clinically, is likely to be increasingly used for AML MRD testing in the future.
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Affiliation(s)
- Jack Ghannam
- Laboratory of Myeloid Malignancies, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Laura W Dillon
- Laboratory of Myeloid Malignancies, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christopher S Hourigan
- Laboratory of Myeloid Malignancies, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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4
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Brooimans RA, van der Velden VHJ, Boeckx N, Slomp J, Preijers F, Te Marvelde JG, Van NM, Heijs A, Huys E, van der Holt B, de Greef GE, Kelder A, Schuurhuis GJ. Immunophenotypic measurable residual disease (MRD) in acute myeloid leukemia: Is multicentric MRD assessment feasible? Leuk Res 2018; 76:39-47. [PMID: 30553189 DOI: 10.1016/j.leukres.2018.11.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/01/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Abstract
Flow-cytometric detection of now termed measurable residual disease (MRD) in acute myeloid leukemia (AML) has proven to have an independent prognostic impact. In a previous multicenter study we developed protocols to accurately define leukemia-associated immunophenotypes (LAIPs) at diagnosis. It has, however, not been demonstrated whether the use of the defined LAIPs in the same multicenter setting results in a high concordance between centers in MRD assessment. In the present paper we evaluated whether interpretation of list-mode data (LMD) files, obtained from MRD assessment of previously determined LAIPs during and after treatment, could reliably be performed in a multicenter setting. The percentage of MRD positive cells was simultaneously determined in totally 173 LMD files from 77 AML patients by six participating centers. The quantitative concordance between the six participating centers was meanly 84%, with slight variation of 75%-89%. In addition our data showed that the type and number of LAIPs were of influence on the performance outcome. The highest concordance was observed for LAIPs with cross-lineage expression, followed by LAIPs with an asynchronous antigen expression. Our results imply that immunophenotypic MRD assessment in AML will only be feasible when fully standardized methods are used for reliable multicenter assessment.
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Affiliation(s)
- Rik A Brooimans
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Laboratory of Clinical and Tumor Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Vincent H J van der Velden
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nancy Boeckx
- Laboratory of Experimental Transplantation, University of Leuven, Leuven, Belgium
| | - Jennita Slomp
- Department of Clinical Chemistry, Medisch Spectrum Twente/Medlon, Enschede, The Netherlands
| | - Frank Preijers
- Department of Laboratory Medicine-Laboratory for Hematology, Radboud UMC, Nijmegen, The Netherlands
| | - Jeroen G Te Marvelde
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ngoc M Van
- Laboratory of Clinical and Tumor Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Antoinette Heijs
- Department of Clinical Chemistry, Medisch Spectrum Twente/Medlon, Enschede, The Netherlands
| | - Erik Huys
- Department of Laboratory Medicine-Laboratory for Hematology, Radboud UMC, Nijmegen, The Netherlands
| | - Bronno van der Holt
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Georgine E de Greef
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Angele Kelder
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
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Gaipa G, Buracchi C, Biondi A. Flow cytometry for minimal residual disease testing in acute leukemia: opportunities and challenges. Expert Rev Mol Diagn 2018; 18:775-787. [DOI: 10.1080/14737159.2018.1504680] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Giuseppe Gaipa
- Department of Pediatrics, University of Milano-Bicocca, Fondazione Tettamanti - Centro Ricerca M.Tettamanti, Monza, Italy
| | - Chiara Buracchi
- Department of Pediatrics, University of Milano-Bicocca, Fondazione Tettamanti - Centro Ricerca M.Tettamanti, Monza, Italy
| | - A Biondi
- Department of Pediatrics, University of Milano-Bicocca, Fondazione Tettamanti - Centro Ricerca M.Tettamanti, Monza, Italy
- Fondazione MBBM/Ospedale San Gerardo - Department of Pediatrics, University of Milano-Bicocca, Monza, Italy
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6
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Buccisano F, Hourigan CS, Walter RB. The Prognostic Significance of Measurable ("Minimal") Residual Disease in Acute Myeloid Leukemia. Curr Hematol Malig Rep 2018; 12:547-556. [PMID: 29027628 DOI: 10.1007/s11899-017-0420-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review was to evaluate recent literature on detection methodologies for, and prognostic significance of, measurable ("minimal") residual disease (MRD) in acute myeloid leukemia (AML). RECENT FINDINGS There is no "one-fits-all" approach to MRD testing in AML. Most exploited to date are methods relying on immunophenotypic aberrancies (identified via multiparameter flow cytometry) or genetic abnormalities (identified via PCR-based assays). Current methods have important shortcomings, including the lack of assay platform standardization/harmonization across laboratories. In parallel to refinements of existing technologies and data analysis/interpretation, new methodologies (e.g., next-generation sequencing-based assays) are emerging that eventually may complement or replace existing ones. This dynamic evolution of MRD testing has complicated comparisons between individual studies. Nonetheless, an ever-growing body of data demonstrates that a positive MRD test at various time points throughout chemotherapy and hematopoietic cell transplantation identifies patients at particularly high risks of disease recurrence and short survival even after adjustment for other risk factors.
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Affiliation(s)
- Francesco Buccisano
- Department of Biomedicine and Prevention, Hematology, University Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.
| | - Christopher S Hourigan
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Roland B Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
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Mosna F, Capelli D, Gottardi M. Minimal Residual Disease in Acute Myeloid Leukemia: Still a Work in Progress? J Clin Med 2017; 6:jcm6060057. [PMID: 28587190 PMCID: PMC5483867 DOI: 10.3390/jcm6060057] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 12/14/2022] Open
Abstract
Minimal residual disease evaluation refers to a series of molecular and immunophenotypical techniques aimed at detecting submicroscopic disease after therapy. As such, its application in acute myeloid leukemia has greatly increased our ability to quantify treatment response, and to determine the chemosensitivity of the disease, as the final product of the drug schedule, dose intensity, biodistribution, and the pharmakogenetic profile of the patient. There is now consistent evidence for the prognostic power of minimal residual disease evaluation in acute myeloid leukemia, which is complementary to the baseline prognostic assessment of the disease. The focus for its use is therefore shifting to individualize treatment based on a deeper evaluation of chemosensitivity and residual tumor burden. In this review, we will summarize the results of the major clinical studies evaluating minimal residual disease in acute myeloid leukemia in adults in recent years and address the technical and practical issues still hampering the spread of these techniques outside controlled clinical trials. We will also briefly speculate on future developments and offer our point of view, and a word of caution, on the present use of minimal residual disease measurements in “real-life” practice. Still, as final standardization and diffusion of the methods are sorted out, we believe that minimal residual disease will soon become the new standard for evaluating response in the treatment of acute myeloid leukemia.
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Affiliation(s)
- Federico Mosna
- Hematology and Bone Marrow Transplantation Unit, Ospedale Centrale "San Maurizio", Azienda Sanitaria dell'Alto Adige, via L. Bohler 5, 39100 Bolzano, Italy.
| | - Debora Capelli
- Hematology, Ospedali Riuniti di Ancona, 60121 Ancona, Italy.
| | - Michele Gottardi
- Hematology, Ospedale "Ca' Foncello", AULSS 2, 31100 Treviso, Italy.
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Hourigan CS, Gale RP, Gormley NJ, Ossenkoppele GJ, Walter RB. Measurable residual disease testing in acute myeloid leukaemia. Leukemia 2017; 31:1482-1490. [PMID: 28386105 DOI: 10.1038/leu.2017.113] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/15/2017] [Accepted: 03/21/2017] [Indexed: 12/24/2022]
Abstract
There is considerable interest in developing techniques to detect and/or quantify remaining leukaemia cells termed measurable or, less precisely, minimal residual disease (MRD) in persons with acute myeloid leukaemia (AML) in complete remission defined by cytomorphological criteria. An important reason for AML MRD-testing is the possibility of estimating the likelihood (and timing) of leukaemia relapse. A perfect MRD-test would precisely quantify leukaemia cells biologically able and likely to cause leukaemia relapse within a defined interval. AML is genetically diverse and there is currently no uniform approach to detecting such cells. Several technologies focused on immune phenotype or cytogenetic and/or molecular abnormalities have been developed, each with advantages and disadvantages. Many studies report a positive MRD-test at diverse time points during AML therapy identifies persons with a higher risk of leukaemia relapse compared with those with a negative MRD-test even after adjusting for other prognostic and predictive variables. No MRD-test in AML has perfect sensitivity and specificity for relapse prediction at the cohort- or subject levels and there are substantial rates of false-positive and -negative tests. Despite these limitations, correlations between MRD-test results and relapse risk have generated interest in MRD-test result-directed therapy interventions. However, convincing proof that a specific intervention will reduce relapse risk in persons with a positive MRD-test is lacking and needs testing in randomized trials. Routine clinical use of MRD-testing requires further refinements and standardization/harmonization of assay platforms and results reporting. Such data are needed to determine whether results of MRD-testing can be used as a surrogate end point in AML therapy trials. This could make drug-testing more efficient and accelerate regulatory approvals. Although MRD-testing in AML has advanced substantially, much remains to be done.
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Affiliation(s)
- C S Hourigan
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - R P Gale
- Haematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK
| | - N J Gormley
- Division of Hematology Products, Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - G J Ossenkoppele
- Division of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - R B Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
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Pettersson L, Levéen P, Axler O, Dvorakova D, Juliusson G, Ehinger M. Improved minimal residual disease detection by targeted quantitative polymerase chain reaction inNucleophosmin 1type a mutated acute myeloid leukemia. Genes Chromosomes Cancer 2016; 55:750-66. [DOI: 10.1002/gcc.22375] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 05/12/2016] [Accepted: 05/13/2016] [Indexed: 12/25/2022] Open
Affiliation(s)
| | - Per Levéen
- Department of Pathology; University and Regional Laboratories, Skåne University Hospital; Lund Sweden
| | - Olof Axler
- Department of Pathology; University and Regional Laboratories, Skåne University Hospital; Lund Sweden
| | - Dana Dvorakova
- Department of Internal Medicine-Hematology and Oncology; Center of Molecular Biology and Gene Therapy, Masaryk University and University Hospital Brno; Brno Czech Republic
| | - Gunnar Juliusson
- Department of Hematology; Skåne University Hospital; Lund Sweden
| | - Mats Ehinger
- Department of Pathology; University and Regional Laboratories, Skåne University Hospital; Lund Sweden
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Minimal residual disease evaluation by flow cytometry is a complementary tool to cytogenetics for treatment decisions in acute myeloid leukaemia. Leuk Res 2015; 40:1-9. [PMID: 26598032 DOI: 10.1016/j.leukres.2015.10.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/07/2015] [Accepted: 10/07/2015] [Indexed: 12/16/2022]
Abstract
The clinical utility of minimal residual disease (MRD) analysis in acute myeloid leukaemia (AML) is not yet defined. We analysed the prognostic impact of MRD level at complete remision after induction therapy using multiparameter flow cytometry in 306 non-APL AML patients. First, we validated the prognostic value of MRD-thresholds we have previously proposed (≥ 0.1%; ≥ 0.01-0.1%; and <0.01), with a 5-year RFS of 38%, 50% and 71%, respectively (p=0.002). Cytogenetics is the most relevant prognosis factor in AML, however intermediate risk cytogenetics represent a grey zone that require other biomarkers for risk stratification, and we show that MRD evaluation discriminate three prognostic subgroups (p=0.03). Also, MRD assessments yielded relevant information on favourable and adverse cytogenetics, since patients with favourable cytogenetics and high MRD levels have poor prognosis and patients with adverse cytogenetics but undetectable MRD overcomes the adverse prognosis. Interestingly, in patients with intermediate or high MRD levels, intensification with transplant improved the outcome as compared with chemotherapy, while the type of intensification therapy did not influenced the outcome of patients with low MRD levels. Multivariate analysis revealed age, MRD and cytogenetics as independent variables. Moreover, a scoring system, easy in clinical practice, was generated based on MRD level and cytogenetics.
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11
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Defining consensus leukemia-associated immunophenotypes for detection of minimal residual disease in acute myeloid leukemia in a multicenter setting. Blood Cancer J 2013; 3:e129. [PMID: 23912609 PMCID: PMC3763381 DOI: 10.1038/bcj.2013.27] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 06/25/2013] [Indexed: 11/29/2022] Open
Abstract
Flow-cytometric detection of minimal residual disease (MRD) has proven in several single-institute studies to have an independent prognostic impact. We studied whether this relatively complex approach could be performed in a multicenter clinical setting. Five centers developed common protocols to accurately define leukemia-associated (immuno)phenotypes (LAPs) at diagnosis required to establish MRD during/after treatment. List mode data files were exchanged, and LAPs were designed by each center. One center, with extensive MRD experience, served as the reference center and coordinator. In quarterly meetings, consensus LAPs were defined, with the performance of centers compared with these. In a learning (29 patients) and a test phase (35 patients), a mean of 2.2 aberrancies/patient was detected, and only 1/63 patients (1.6%) had no consensus LAP(s). For the four centers without (extensive) MRD experience, clear improvement could be shown: in the learning phase, 39–63% of all consensus LAPs were missed, resulting in a median 30% of patients (range 21–33%) for whom no consensus LAP was reported; in the test phase, 27–40% missed consensus LAPs, resulting in a median 16% (range 7–18%) of ‘missed' patients. The quality of LAPs was extensively described. Immunophenotypic MRD assessment in its current setting needs extensive experience and should be limited to experienced centers.
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12
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Xu XJ, Tang YM, Shen HQ, Song H, Yang SL, Shi SW, Xu WQ. Day 22 of induction therapy is important for minimal residual disease assessment by flow cytometry in childhood acute lymphoblastic leukemia. Leuk Res 2012; 36:1022-7. [DOI: 10.1016/j.leukres.2012.03.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 03/12/2012] [Accepted: 03/14/2012] [Indexed: 12/27/2022]
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Hokland P, Ommen HB, Nyvold CG, Roug AS. Sensitivity of minimal residual disease in acute myeloid leukaemia in first remission - methodologies in relation to their clinical situation. Br J Haematol 2012; 158:569-80. [DOI: 10.1111/j.1365-2141.2012.09203.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 05/07/2012] [Indexed: 12/16/2022]
Affiliation(s)
- Peter Hokland
- Department of Haematology; Aarhus University Hospital; Aarhus; Denmark
| | - Hans Beier Ommen
- Department of Haematology; Aarhus University Hospital; Aarhus; Denmark
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14
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Ossenkoppele GJ, van de Loosdrecht AA, Schuurhuis GJ. Review of the relevance of aberrant antigen expression by flow cytometry in myeloid neoplasms. Br J Haematol 2011; 153:421-36. [PMID: 21385170 DOI: 10.1111/j.1365-2141.2011.08595.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article reviews the use of aberrant antigen expression detected by flow cytometry in the diagnosis and clinical handling of acute myeloid leukaemia (AML) and the myelodysplastic syndromes (MDS). Such aberrancies offer a valuable tool for the proper classification of these myeloid malignancies according the World Health Organization 2008 classification. Aberrant antigen expression by flow cytometry is also important for prognostification. This review supports the view, that minimal residual disease detection methods that make use of such aberrancies should be part of the routine management of AML patients to guide therapy, but also suggests the introduction of flow cytometry in MDS for diagnosis and treatment decisions in the near future.
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Affiliation(s)
- Gert J Ossenkoppele
- Department of Haematology, VU University Medical Center, De Boelelaan 1117, Amsterdam, the Netherlands.
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Peters JM, Ansari MQ. Multiparameter flow cytometry in the diagnosis and management of acute leukemia. Arch Pathol Lab Med 2011; 135:44-54. [PMID: 21204710 DOI: 10.5858/2010-0387-rar.1] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Timely and accurate diagnosis of hematologic malignancies is crucial to appropriate clinical management. Acute leukemias are a diverse group of malignancies with a range of clinical presentations, prognoses, and preferred treatment protocols. Historical classification systems relied predominantly on morphologic and cytochemical features, but currently, immunophenotypic, cytogenetic, and molecular data are incorporated to define clinically relevant diagnostic categories. Multiparameter flow cytometry provides rapid and detailed determination of antigen expression profiles in acute leukemias which, in conjunction with morphologic assessment, often suggests a definitive diagnosis or a narrow differential. Many recurrent molecular or cytogenetic aberrations are associated with distinct immunophenotypic features, and therefore flow cytometry is an important tool to direct further testing. In addition, detection of specific antigens may have prognostic or therapeutic implications even within a single acute leukemia subtype. After initial diagnosis, a leukemia's immunophenotypic fingerprint provides a useful reference to monitor response to therapy, minimal residual disease, and recurrence. OBJECTIVE To provide an overview of the application of flow cytometric immunophenotyping to the diagnosis and management of acute leukemias, including salient features of those entities described in the 2008 World Health Organization classification. DATA SOURCES Published articles pertaining to flow cytometry, acute leukemia classification, and experiences of a reference flow cytometry laboratory. CONCLUSION Immunophenotypic evaluation is essential to accurate diagnosis and classification of acute leukemia. Multiparameter flow cytometry provides a rapid and effective means to collect this information, as well as providing prognostic information and a modality for minimal residual disease evaluation.
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Affiliation(s)
- John M Peters
- Department of Pathology, Southwestern Medical School, 5323 Harry Hines Blvd., Dallas, TX 75390-9073, USA
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Buccisano F, Maurillo L, Spagnoli A, Principe MID, Ceresoli E, Coco FL, Arcese W, Amadori S, Venditti A. Monitoring of minimal residual disease in acute myeloid leukemia. Curr Opin Oncol 2009; 21:582-8. [DOI: 10.1097/cco.0b013e3283311856] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rudenko HC, Else M, Dearden C, Brito-Babapulle V, Jones C, Dexter T, Fenwick K, Mackay A, Ashworth A, Matutes E, Gonzalez D, Catovsky D, Morgan GJ. Characterising the TP53-deleted subgroup of chronic lymphocytic leukemia: an analysis of additional cytogenetic abnormalities detected by interphase fluorescencein situhybridisation and array-based comparative genomic hybridisation. Leuk Lymphoma 2009; 49:1879-86. [DOI: 10.1080/10428190802345902] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schetelig J, van Biezen A, Brand R, Caballero D, Martino R, Itala M, García-Marco JA, Volin L, Schmitz N, Schwerdtfeger R, Ganser A, Onida F, Mohr B, Stilgenbauer S, Bornhäuser M, de Witte T, Dreger P. Allogeneic Hematopoietic Stem-Cell Transplantation for Chronic Lymphocytic Leukemia With 17p Deletion: A Retrospective European Group for Blood and Marrow Transplantation Analysis. J Clin Oncol 2008; 26:5094-100. [DOI: 10.1200/jco.2008.16.2982] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Purpose Patients with chronic lymphocytic leukemia (CLL) and 17p deletion (17p–) have a poor prognosis. Although allogeneic hematopoietic stem-cell transplantation (HCT) has the potential to cure patients with advanced CLL, it is not known whether this holds true for patients with 17p–CLL. Patients and Methods Baseline data from patients, for whom information on the presence of 17p–CLL was available, were downloaded from the European Group for Blood and Marrow Transplantation database. Additional information on the course of CLL and follow-up was collected with a questionnaire. Results A total of 44 patients with 17p–CLL received allogeneic HCT between March 1995 and July 2006 from a matched sibling (n = 24) or an alternative donor (n = 20). 17p–CLL had been diagnosed by fluorescent in situ hybridization in 82% of patients and by conventional banding in 18% of patients. The median age was 54 years. Before HCT, a median of three lines of chemotherapy had been administered. At HCT, 53% of patients were in remission. Reduced-intensity conditioning was applied in 89% of patients. Acute, grade 2 to 4 graft-versus-host disease (GVHD) occurred in 43% of patients, and extensive chronic GVHD occurred in 53% of patients. At last follow-up, 19 patients were alive, with a median observation time of 39 months (range, 18 to 101 months). Three-year overall survival and progression-free survival rates were 44% and 37%, respectively. The cumulative incidence of progressive disease at 4 years was 34%. No late relapse occurred in nine patients with a follow-up longer than 4 years. Conclusion Allogeneic HCT has the potential to induce long-term disease-free survival in patients with 17p–CLL.
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Affiliation(s)
- Johannes Schetelig
- From the University Hospital Carl Gustav Carus, Medizinische Klinik und Poliklinik I, Dresden; Department of Haematology and Stem Cell Transplantation, Asklepios Klinik St Georg, Hamburg; Deutsche Klinik für Diagnostik, Knochenmarktransplantation, Wiesbaden; Hannover Medical University, Department of Haematology/Oncology, Hannover; University Hospital, Medizinische Klinik und Poliklinik III, Ulm; University Hospital Heidelberg, Medizinische Klinik V, Heidelberg, Germany; Hospital Clínico, Servicio de
| | - Anja van Biezen
- From the University Hospital Carl Gustav Carus, Medizinische Klinik und Poliklinik I, Dresden; Department of Haematology and Stem Cell Transplantation, Asklepios Klinik St Georg, Hamburg; Deutsche Klinik für Diagnostik, Knochenmarktransplantation, Wiesbaden; Hannover Medical University, Department of Haematology/Oncology, Hannover; University Hospital, Medizinische Klinik und Poliklinik III, Ulm; University Hospital Heidelberg, Medizinische Klinik V, Heidelberg, Germany; Hospital Clínico, Servicio de
| | - Ronald Brand
- From the University Hospital Carl Gustav Carus, Medizinische Klinik und Poliklinik I, Dresden; Department of Haematology and Stem Cell Transplantation, Asklepios Klinik St Georg, Hamburg; Deutsche Klinik für Diagnostik, Knochenmarktransplantation, Wiesbaden; Hannover Medical University, Department of Haematology/Oncology, Hannover; University Hospital, Medizinische Klinik und Poliklinik III, Ulm; University Hospital Heidelberg, Medizinische Klinik V, Heidelberg, Germany; Hospital Clínico, Servicio de
| | - Dolores Caballero
- From the University Hospital Carl Gustav Carus, Medizinische Klinik und Poliklinik I, Dresden; Department of Haematology and Stem Cell Transplantation, Asklepios Klinik St Georg, Hamburg; Deutsche Klinik für Diagnostik, Knochenmarktransplantation, Wiesbaden; Hannover Medical University, Department of Haematology/Oncology, Hannover; University Hospital, Medizinische Klinik und Poliklinik III, Ulm; University Hospital Heidelberg, Medizinische Klinik V, Heidelberg, Germany; Hospital Clínico, Servicio de
| | - Rodrigo Martino
- From the University Hospital Carl Gustav Carus, Medizinische Klinik und Poliklinik I, Dresden; Department of Haematology and Stem Cell Transplantation, Asklepios Klinik St Georg, Hamburg; Deutsche Klinik für Diagnostik, Knochenmarktransplantation, Wiesbaden; Hannover Medical University, Department of Haematology/Oncology, Hannover; University Hospital, Medizinische Klinik und Poliklinik III, Ulm; University Hospital Heidelberg, Medizinische Klinik V, Heidelberg, Germany; Hospital Clínico, Servicio de
| | - Maija Itala
- From the University Hospital Carl Gustav Carus, Medizinische Klinik und Poliklinik I, Dresden; Department of Haematology and Stem Cell Transplantation, Asklepios Klinik St Georg, Hamburg; Deutsche Klinik für Diagnostik, Knochenmarktransplantation, Wiesbaden; Hannover Medical University, Department of Haematology/Oncology, Hannover; University Hospital, Medizinische Klinik und Poliklinik III, Ulm; University Hospital Heidelberg, Medizinische Klinik V, Heidelberg, Germany; Hospital Clínico, Servicio de
| | - José A. García-Marco
- From the University Hospital Carl Gustav Carus, Medizinische Klinik und Poliklinik I, Dresden; Department of Haematology and Stem Cell Transplantation, Asklepios Klinik St Georg, Hamburg; Deutsche Klinik für Diagnostik, Knochenmarktransplantation, Wiesbaden; Hannover Medical University, Department of Haematology/Oncology, Hannover; University Hospital, Medizinische Klinik und Poliklinik III, Ulm; University Hospital Heidelberg, Medizinische Klinik V, Heidelberg, Germany; Hospital Clínico, Servicio de
| | - Liisa Volin
- From the University Hospital Carl Gustav Carus, Medizinische Klinik und Poliklinik I, Dresden; Department of Haematology and Stem Cell Transplantation, Asklepios Klinik St Georg, Hamburg; Deutsche Klinik für Diagnostik, Knochenmarktransplantation, Wiesbaden; Hannover Medical University, Department of Haematology/Oncology, Hannover; University Hospital, Medizinische Klinik und Poliklinik III, Ulm; University Hospital Heidelberg, Medizinische Klinik V, Heidelberg, Germany; Hospital Clínico, Servicio de
| | - Norbert Schmitz
- From the University Hospital Carl Gustav Carus, Medizinische Klinik und Poliklinik I, Dresden; Department of Haematology and Stem Cell Transplantation, Asklepios Klinik St Georg, Hamburg; Deutsche Klinik für Diagnostik, Knochenmarktransplantation, Wiesbaden; Hannover Medical University, Department of Haematology/Oncology, Hannover; University Hospital, Medizinische Klinik und Poliklinik III, Ulm; University Hospital Heidelberg, Medizinische Klinik V, Heidelberg, Germany; Hospital Clínico, Servicio de
| | - Rainer Schwerdtfeger
- From the University Hospital Carl Gustav Carus, Medizinische Klinik und Poliklinik I, Dresden; Department of Haematology and Stem Cell Transplantation, Asklepios Klinik St Georg, Hamburg; Deutsche Klinik für Diagnostik, Knochenmarktransplantation, Wiesbaden; Hannover Medical University, Department of Haematology/Oncology, Hannover; University Hospital, Medizinische Klinik und Poliklinik III, Ulm; University Hospital Heidelberg, Medizinische Klinik V, Heidelberg, Germany; Hospital Clínico, Servicio de
| | - Arnold Ganser
- From the University Hospital Carl Gustav Carus, Medizinische Klinik und Poliklinik I, Dresden; Department of Haematology and Stem Cell Transplantation, Asklepios Klinik St Georg, Hamburg; Deutsche Klinik für Diagnostik, Knochenmarktransplantation, Wiesbaden; Hannover Medical University, Department of Haematology/Oncology, Hannover; University Hospital, Medizinische Klinik und Poliklinik III, Ulm; University Hospital Heidelberg, Medizinische Klinik V, Heidelberg, Germany; Hospital Clínico, Servicio de
| | - Francesco Onida
- From the University Hospital Carl Gustav Carus, Medizinische Klinik und Poliklinik I, Dresden; Department of Haematology and Stem Cell Transplantation, Asklepios Klinik St Georg, Hamburg; Deutsche Klinik für Diagnostik, Knochenmarktransplantation, Wiesbaden; Hannover Medical University, Department of Haematology/Oncology, Hannover; University Hospital, Medizinische Klinik und Poliklinik III, Ulm; University Hospital Heidelberg, Medizinische Klinik V, Heidelberg, Germany; Hospital Clínico, Servicio de
| | - Brigitte Mohr
- From the University Hospital Carl Gustav Carus, Medizinische Klinik und Poliklinik I, Dresden; Department of Haematology and Stem Cell Transplantation, Asklepios Klinik St Georg, Hamburg; Deutsche Klinik für Diagnostik, Knochenmarktransplantation, Wiesbaden; Hannover Medical University, Department of Haematology/Oncology, Hannover; University Hospital, Medizinische Klinik und Poliklinik III, Ulm; University Hospital Heidelberg, Medizinische Klinik V, Heidelberg, Germany; Hospital Clínico, Servicio de
| | - Stephan Stilgenbauer
- From the University Hospital Carl Gustav Carus, Medizinische Klinik und Poliklinik I, Dresden; Department of Haematology and Stem Cell Transplantation, Asklepios Klinik St Georg, Hamburg; Deutsche Klinik für Diagnostik, Knochenmarktransplantation, Wiesbaden; Hannover Medical University, Department of Haematology/Oncology, Hannover; University Hospital, Medizinische Klinik und Poliklinik III, Ulm; University Hospital Heidelberg, Medizinische Klinik V, Heidelberg, Germany; Hospital Clínico, Servicio de
| | - Martin Bornhäuser
- From the University Hospital Carl Gustav Carus, Medizinische Klinik und Poliklinik I, Dresden; Department of Haematology and Stem Cell Transplantation, Asklepios Klinik St Georg, Hamburg; Deutsche Klinik für Diagnostik, Knochenmarktransplantation, Wiesbaden; Hannover Medical University, Department of Haematology/Oncology, Hannover; University Hospital, Medizinische Klinik und Poliklinik III, Ulm; University Hospital Heidelberg, Medizinische Klinik V, Heidelberg, Germany; Hospital Clínico, Servicio de
| | - Theo de Witte
- From the University Hospital Carl Gustav Carus, Medizinische Klinik und Poliklinik I, Dresden; Department of Haematology and Stem Cell Transplantation, Asklepios Klinik St Georg, Hamburg; Deutsche Klinik für Diagnostik, Knochenmarktransplantation, Wiesbaden; Hannover Medical University, Department of Haematology/Oncology, Hannover; University Hospital, Medizinische Klinik und Poliklinik III, Ulm; University Hospital Heidelberg, Medizinische Klinik V, Heidelberg, Germany; Hospital Clínico, Servicio de
| | - Peter Dreger
- From the University Hospital Carl Gustav Carus, Medizinische Klinik und Poliklinik I, Dresden; Department of Haematology and Stem Cell Transplantation, Asklepios Klinik St Georg, Hamburg; Deutsche Klinik für Diagnostik, Knochenmarktransplantation, Wiesbaden; Hannover Medical University, Department of Haematology/Oncology, Hannover; University Hospital, Medizinische Klinik und Poliklinik III, Ulm; University Hospital Heidelberg, Medizinische Klinik V, Heidelberg, Germany; Hospital Clínico, Servicio de
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Current Awareness in Hematological Oncology. Hematol Oncol 2007. [DOI: 10.1002/hon.798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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van Rhenen A, Moshaver B, Ossenkoppele GJ, Schuurhuis GJ. New approaches for the detection of minimal residual disease in acute myeloid leukemia. Curr Hematol Malig Rep 2007; 2:111-8. [DOI: 10.1007/s11899-007-0016-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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