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Jia X, Liao N, Yu S, Li H, Liu H, Zhang H, Xu J, Yao Y, He H, Yu G, Liu Q, Zhang Y, Shi P. Impact of measurable residual disease in combination with CD19 on postremission therapy choices for adult t(8;21) acute myeloid leukemia in first complete remission. Cancer Med 2024; 13:e7074. [PMID: 38457215 PMCID: PMC10922018 DOI: 10.1002/cam4.7074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The post-remission therapy (PRT) choices for adult t(8;21) acute myeloid leukemia (AML) in first complete remission (CR1) need to be further explored. AIMS We aimed to investigate the impact of measurable residual disease (MRD) combined with CD19 on PRT choices for adult t(8;21) AML in CR1. METHODS A total of 150 t(8;21) AML patients were enrolled, including 67 underwent chemotherapy (CMT) and 83 allogeneic hematopoietic stem cell transplantation (allo-SCT) as PRT in CR1. Subgroup analyses were performed according to MRD level after three cycles of chemotherapy combined with CD19 expression. RESULTS Multivariate analysis indicated MRDhigh after three courses of treatment (HR, 0.14 [95% CI, 0.03-0.66]; p = 0.013) and CD19 negativity (HR, 0.14 [95% CI, 0.02-0.96]; p = 0.045) were risk factors for relapse, while allo-SCT was protective factor for relapse (HR, 0.34 [95% CI, 0.15-0.75]; p = 0.008). Grouped by MRD after three courses of chemotherapy, allo-SCT had lower CIR (p < 0.001) and better OS (p = 0.003) than CMT for MRDhigh patients, CMT showed a higher CIR (35.99% vs. 15.34%, p = 0.100) but comparable OS (p = 0.588) than allo-SCT for MRDlow patients. Grouped by CD19 expression, allo-SCT demonstrated lower CIR (p < 0.001) and better OS (p = 0.002) than CMT for CD19- patients. CMT had a higher CIR (41.37% vs. 10.48%, p = 0.007) but comparable OS (p = 0.147) than allo-SCT for CD19+ patients. Grouped by MRD combined with CD19, MRDhigh /CD19+ subsets were identified out of CD19+ patients benefiting from allo-SCT with lower CIR (p = 0.002) and superior OS (p = 0.020) than CMT. CMT preserved comparable CIR (p = 0.939) and OS (p = 0.658) with allo-SCT for MRDlow /CD19+ patients. MRDlow /CD19- subsets were also identified from MRDlow patients requiring allo-SCT with lower CIR (p < 0.001) and superior OS (p = 0.008) than CMT. Allo-SCT maintained lower CIR (p < 0.001) and superior OS (p = 0.008) than CMT for MRDhigh /CD19- patients. CONCLUSIONS MRD combined with CD19 might optimize PRT choices for adult t(8;21) AML patients in CR1.
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Affiliation(s)
- Xi Jia
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
| | - Naying Liao
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
| | - Sijian Yu
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
| | - Huan Li
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
| | - Hui Liu
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
| | - Haiyan Zhang
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
| | - Jun Xu
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
| | - Yunqian Yao
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
| | - Han He
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
| | - Guopan Yu
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
| | - Qifa Liu
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
| | - Yu Zhang
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
| | - Pengcheng Shi
- Department of Hematology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Clinical Medical Research Center of Hematological Diseases of Guangdong ProvinceGuangzhouChina
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Molecular Measurable Residual Disease Assessment before Hematopoietic Stem Cell Transplantation in Pediatric Acute Myeloid Leukemia Patients: A Retrospective Study by the I-BFM Study Group. Biomedicines 2022; 10:biomedicines10071530. [PMID: 35884834 PMCID: PMC9313005 DOI: 10.3390/biomedicines10071530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/14/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is a curative post-remission treatment in patients with acute myeloid leukemia (AML), but relapse after transplant is still a challenging event. In recent year, several studies have investigated the molecular minimal residual disease (qPCR-MRD) as a predictor of relapse, but the lack of standardized protocols, cut-offs, and timepoints, especially in the pediatric setting, has prevented its use in several settings, including before HSCT. Here, we propose the first collaborative retrospective I-BFM-AML study assessing qPCR-MRD values in pretransplant bone marrow samples of 112 patients with a diagnosis of AML harboring t(8;21)(q22; q22)RUNX1::RUNX1T1, or inv(16)(p13q22)CBFB::MYH11, or t(9;11)(p21;q23)KMT2A::MLLT3, or FLT3-ITD genetic markers. We calculated an ROC cut-off of 2.1 × 10−4 that revealed significantly increased OS (83.7% versus 57.1%) and EFS (80.2% versus 52.9%) for those patients with lower qPCR-MRD values. Then, we partitioned patients into three qPCR-MRD groups by combining two different thresholds, 2.1 × 10−4 and one lower cut-off of 1 × 10−2, and stratified patients into low-, intermediate-, and high-risk groups. We found that the 5-year OS (83.7%, 68.6%, and 39.2%, respectively) and relapse-free survival (89.2%, 73.9%, and 67.9%, respectively) were significantly different independent of the genetic lesion, conditioning regimen, donor, and stem cell source. These data support the PCR-based approach playing a clinical relevance in AML transplant management.
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Wang Y, Yan J, Chen J, Wang C, Lin Y, Wu Y, Hu R. Comparison of the anxiety, depression and their relationship to quality of life among adult acute leukemia patients and their family caregivers: a cross-sectional study in China. Qual Life Res 2021; 30:1891-1901. [PMID: 33595826 DOI: 10.1007/s11136-021-02785-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE To compare the anxiety, depression and explore their relationship to quality of life (QoL) among adult acute leukemia (AL) patients and family caregivers (FCs) in China. METHODS A multicenter cross-sectional study was conducted from April 2017 to January 2018. The sample comprised 207 dyads of adult AL patients and FCs. The participants were required to complete socio-demographic information and the Hospital Anxiety and Depression Scale (HADS). The Functional Assessment of Cancer Therapy-Leukemia (FACT-Leu, only for patients) and MOS 36-item Short-Form Health Survey (SF-36, only for FCs) were used to measure QoL. RESULTS The mean scores of anxiety and depression for AL patients were 7.89 ± 3.85 and 7.18 ± 4.23, respectively. For FCs, the mean scores of anxiety and depression were 9.96 ± 3.73 and 8.64 ± 3.74. In this study, adult AL Patients' sex, patients' depression score, whether patients achieving a CR or not, education, FCs' depression score, patients' social/family well-being and emotional well-being were significantly associated with patients' anxiety or depression (p < 0.05). For FCs, depression was significantly related to the physical component summary (β = 0.127, p = 0.008). There were significant differences in anxiety (t = - 5.92, p < 0.001) and depression (t = - 4.19, p < 0.001) between patients and FCs. CONCLUSIONS AL patients' FCs showed higher score of anxiety and depression than that of patients. The psychological health may have a potential relationship between AL patients and their FCs. Healthcare professionals can conduct family-center interventions to improve mental health and QoL of AL patients and FCs.
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Affiliation(s)
- Ying Wang
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Jie Yan
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - JingYi Chen
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - ChunFeng Wang
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - YingChun Lin
- Department of Hematology, The First Affiliated Hospital of Fujian University, NO.1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, 350122, Fujian Province, China
| | - Yong Wu
- Department of Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, 29 Xinquan Road, Fuzhou, 350001, China.
| | - Rong Hu
- The School of Nursing, Fujian Medical University, Fuzhou, China.
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Sun YQ, Li SQ, Zhao XS, Chang YJ. Measurable residual disease of acute lymphoblastic leukemia in allograft settings: how to evaluate and intervene. Expert Rev Anticancer Ther 2020; 20:453-464. [PMID: 32459519 DOI: 10.1080/14737140.2020.1766973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a curable strategy for acute lymphoblastic leukemia (ALL), especially for adult cases. However, leukemia relapse after allograft restricts the improvement of transplant outcomes. Measurable residual disease (MRD) has been the strongest predictor for relapse after allo-HSCT, allowing MRD-directed preemptive therapy. AREAS COVERED This manuscript summarizes the detection of MRD in patients with ALL who undergo allo-HSCT, focusing the effects of positive pre-HSCT MRD and post-HSCT MRD on outcomes as well as MRD-directed interventions. EXPERT OPINION Except for MFC and RQ-PCR, other strategies, such as next-generation sequencing and RNAseq, have been developed for MRD determination. Negative effects of positive MRD peri-transplantation on outcomes of ALL patients were observed both in human leukocyte antigen (HLA)-matched sibling donor transplantation and in alternative donor transplantation. Advances have been made in determining the need for transplant according to MRD evaluation after induction or consolidation therapy. A number of approaches, including CAR-T-cell therapy, antibodies (blinatumomab, etc), targeted therapy (imatinib, etc), transplant donor selection, as well as donor lymphocyte infusion and interferon-α, have been successfully used or are promising for peri-transplantation MRD interventions. This progress could lead to the significant improvement of transplant outcomes for ALL patients.
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Affiliation(s)
- Yu-Qian Sun
- National Clinical Research Center for Hematologic Disease, Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation , Beijing, P.R.C
| | - Si-Qi Li
- National Clinical Research Center for Hematologic Disease, Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation , Beijing, P.R.C
| | - Xiao-Su Zhao
- National Clinical Research Center for Hematologic Disease, Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation , Beijing, P.R.C
| | - Ying-Jun Chang
- National Clinical Research Center for Hematologic Disease, Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation , Beijing, P.R.C
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Rubio-Jurado B, Sosa-Quintero LS, Carrasco-Martinez IL, Norato-Delgado A, Garcia-Luna E, Guzmán-Silahua S, Riebeling-Navarro C, Nava-Zavala AH. New biomarkers in non-Hodgkin lymphoma and acute leukemias. Adv Clin Chem 2020; 96:19-53. [PMID: 32362319 DOI: 10.1016/bs.acc.2019.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Biomarkers play a critical role in the medical care of patients with cancer, including in early detection of the disease, diagnostic accuracy, risk stratification, treatment, and follow-up. Biomarkers in hematological malignancies can support the redefinition of the diagnosis and adjustments in the treatment plan. Biomarkers can be classified into 4 categories: (1) protein antigens, (2) cytogenetic abnormalities, (3) genetic polymorphisms, and (4) gene expression. Efforts in genomics, proteomics, and metabolomics to observe new biomarkers that contribute to the development of clinical medicine with greater precision in the strategies that improve prevention, diagnosis, and treatment of patients with malignant hematological disease. New biomarkers should accomplish several issues such as the biological plausibility, methodology used, analytical validation, intellectual property registry, and legal framework of application. This knowledge should be transferred to health professionals who can carry out the process of its implementation in clinical practice.
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Affiliation(s)
- Benjamín Rubio-Jurado
- Departamento Clínico de Hematologia, Division Onco-Hematologia, UMAE, Hospital de Especialidades (HE), Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, Mexico; Unidad de Investigación Biomédica 02, UMAE HE, CMNO, IMSS, Guadalajara, Jalisco, Mexico; Extensión, Consulting and Research Division, Universidad de Monterrey, San Pedro Garza Garcia, Mexico
| | - Lluvia Sugey Sosa-Quintero
- Departamento Clínico de Hematologia, Division Onco-Hematologia, UMAE, Hospital de Especialidades (HE), Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, Mexico
| | - Ivette Lenina Carrasco-Martinez
- Departamento Clínico de Hematologia, Division Onco-Hematologia, UMAE, Hospital de Especialidades (HE), Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, Mexico
| | - Armando Norato-Delgado
- Servicio de Hematologia, HGZ No. 21, IMSS, Cerro de Picachos 852, Col Jardines oriente, Tepatitlán, Jalisco, Mexico
| | - Eduardo Garcia-Luna
- Vice-Rector, División de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Sandra Guzmán-Silahua
- Unidad de Investigación Biomédica 02, UMAE HE, CMNO, IMSS, Guadalajara, Jalisco, Mexico
| | - Carlos Riebeling-Navarro
- Unidad de Investigación en Epidemiología Clínica, UMAE, Hospital de Pediatría CMNS-XXI, IMSS/UNAM, Mexico City, Mexico
| | - Arnulfo Hernan Nava-Zavala
- Unidad de Investigación Biomédica 02, UMAE HE, CMNO, IMSS, Guadalajara, Jalisco, Mexico; Programa Internacional, Facultad de Medicina, Universidad Autónoma de Guadalajara, Zapopan, Jalisco, Mexico; Departamento de Inmunologia y Reumatologia, Hospital General de Occidente, Secretaria de Salud Jalisco, Zapopan, Jalisco, Mexico.
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Richardson DR, Foster MC, Coombs CC, Zeidner JF. Advances in Genomic Profiling and Risk Stratification in Acute Myeloid Leukemia. Semin Oncol Nurs 2019; 35:150957. [PMID: 31759819 DOI: 10.1016/j.soncn.2019.150957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To review the current state of molecular and genetic profiling of acute myeloid leukemia (AML) and its implications. DATA SOURCE Peer-reviewed journal articles. CONCLUSION Significant advances in the understanding of the pathology of acute myeloid leukemia have led to refined risk stratification of patients and application of novel targeted therapies based on genetic profiles. Minimal residual disease testing allows for highly sensitive disease surveillance that can be used to predict relapse and assess treatment response. IMPLICATIONS FOR NURSING PRACTICE Accurate prognostication and therapeutic decision-making for patients with acute myeloid leukemia is dependent on molecular profiling. Being knowledgeable of the implications of minimal residual disease testing is critical for patient-centered care.
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Affiliation(s)
- Daniel R Richardson
- UNC Lineberger Comprehensive Cancer Center, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC; The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Matthew C Foster
- UNC Lineberger Comprehensive Cancer Center, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Catherine C Coombs
- UNC Lineberger Comprehensive Cancer Center, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Joshua F Zeidner
- UNC Lineberger Comprehensive Cancer Center, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Huang XT, Li X, Xie ML, Huang Z, Huang YX, Wu GX, Peng ZR, Sun YN, Ming QL, Liu YX, Chen JP, Xu SN. Resveratrol: Review on its discovery, anti-leukemia effects and pharmacokinetics. Chem Biol Interact 2019; 306:29-38. [PMID: 30954463 DOI: 10.1016/j.cbi.2019.04.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/21/2019] [Accepted: 04/01/2019] [Indexed: 12/27/2022]
Abstract
Resveratrol, found in variety of plants, is a natural stilbene structure polyphenol. It has various pharmacological effects, such as antioxidation, anti-aging, anti-inflammation, anti-cancer, antiobesity, anti-diabetes, cardioprotection, neuroprotection. Recently, anti-leukemia activities of resveratrol has been studied extensively via its effects on a variety of biological processes involving cell proliferation, apoptosis, autophagy. Current treatments of leukemia mainly rely on intensive chemotherapy or hematopoietic stem cell transplantation, however, these treatments are still with poor survival and high treatment-related mortality. Therefore, it is extremely needed to find relatively non-toxic medicines with minimal side effects but sufficient therapeutic efficacy. Resveratrol is one such potential candidate owing to its reported anti-leukemia effect. In this review, we summarized resveratrol's discovery, sources and isolation methods, administration methods, effects in different types of leukemia, pharmacokinetics and toxicities, aiming to exploit resveratrol as a potential drug candidate for anti-leukemia.
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Affiliation(s)
- Xiang-Tao Huang
- Center of Hematology, Key Laboratory of Tumor Immunotherapy of Chongqing, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, PR China
| | - Xi Li
- Center of Hematology, Key Laboratory of Tumor Immunotherapy of Chongqing, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, PR China
| | - Ming-Ling Xie
- Center of Hematology, Key Laboratory of Tumor Immunotherapy of Chongqing, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, PR China
| | - Zhen Huang
- Center of Hematology, Key Laboratory of Tumor Immunotherapy of Chongqing, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, PR China
| | - Yong-Xiu Huang
- Center of Hematology, Key Laboratory of Tumor Immunotherapy of Chongqing, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, PR China
| | - Gui-Xian Wu
- Center of Hematology, Key Laboratory of Tumor Immunotherapy of Chongqing, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, PR China
| | - Zhi-Rong Peng
- Center of Hematology, Key Laboratory of Tumor Immunotherapy of Chongqing, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, PR China
| | - Yan-Ni Sun
- Center of Hematology, Key Laboratory of Tumor Immunotherapy of Chongqing, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, PR China
| | - Qian-Liang Ming
- College of Pharmacy, Third Military Medical University (Army Medical University), Chongqing, 400038, PR China
| | - Yan-Xia Liu
- College of Pharmacy, Third Military Medical University (Army Medical University), Chongqing, 400038, PR China
| | - Jie-Ping Chen
- Center of Hematology, Key Laboratory of Tumor Immunotherapy of Chongqing, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, PR China.
| | - Shuang-Nian Xu
- Center of Hematology, Key Laboratory of Tumor Immunotherapy of Chongqing, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, PR China.
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Rautenberg C, Germing U, Haas R, Kobbe G, Schroeder T. Relapse of Acute Myeloid Leukemia after Allogeneic Stem Cell Transplantation: Prevention, Detection, and Treatment. Int J Mol Sci 2019; 20:E228. [PMID: 30626126 PMCID: PMC6337734 DOI: 10.3390/ijms20010228] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 12/12/2022] Open
Abstract
Acute myeloid leukemia (AML) is a phenotypically and prognostically heterogeneous hematopoietic stem cell disease that may be cured in eligible patients with intensive chemotherapy and/or allogeneic stem cell transplantation (allo-SCT). Tremendous advances in sequencing technologies have revealed a large amount of molecular information which has markedly improved our understanding of the underlying pathophysiology and enables a better classification and risk estimation. Furthermore, with the approval of the FMS-like tyrosine kinase 3 (FLT3) inhibitor Midostaurin a first targeted therapy has been introduced into the first-line therapy of younger patients with FLT3-mutated AML and several other small molecules targeting molecular alterations such as isocitrate dehydrogenase (IDH) mutations or the anti-apoptotic b-cell lymphoma 2 (BCL-2) protein are currently under investigation. Despite these advances, many patients will have to undergo allo-SCT during the course of disease and depending on disease and risk status up to half of them will finally relapse after transplant. Here we review the current knowledge about the molecular landscape of AML and how this can be employed to prevent, detect and treat relapse of AML after allo-SCT.
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MESH Headings
- Antineoplastic Agents/therapeutic use
- Hematopoietic Stem Cell Transplantation
- Humans
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/prevention & control
- Leukemia, Myeloid, Acute/therapy
- Mutation/genetics
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/drug therapy
- Recurrence
- Transplantation, Homologous
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Affiliation(s)
- Christina Rautenberg
- Department of Hematology, Oncology and Clinical Immunology, University of Duesseldorf, Medical Faculty, 40225 Duesseldorf, Germany.
| | - Ulrich Germing
- Department of Hematology, Oncology and Clinical Immunology, University of Duesseldorf, Medical Faculty, 40225 Duesseldorf, Germany.
| | - Rainer Haas
- Department of Hematology, Oncology and Clinical Immunology, University of Duesseldorf, Medical Faculty, 40225 Duesseldorf, Germany.
| | - Guido Kobbe
- Department of Hematology, Oncology and Clinical Immunology, University of Duesseldorf, Medical Faculty, 40225 Duesseldorf, Germany.
| | - Thomas Schroeder
- Department of Hematology, Oncology and Clinical Immunology, University of Duesseldorf, Medical Faculty, 40225 Duesseldorf, Germany.
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Minimal/Measurable Residual Disease Monitoring in NPM1-Mutated Acute Myeloid Leukemia: A Clinical Viewpoint and Perspectives. Int J Mol Sci 2018; 19:ijms19113492. [PMID: 30404199 PMCID: PMC6274702 DOI: 10.3390/ijms19113492] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/02/2018] [Accepted: 11/03/2018] [Indexed: 02/06/2023] Open
Abstract
Acute myeloid leukemia (AML) with NPM1 gene mutations is currently recognized as a distinct entity, due to its unique biological and clinical features. We summarize here the results of published studies investigating the clinical application of minimal/measurable residual disease (MRD) in patients with NPM1-mutated AML, receiving either intensive chemotherapy or hematopoietic stem cell transplantation. Several clinical trials have so far demonstrated a significant independent prognostic impact of molecular MRD monitoring in NPM1-mutated AML and, accordingly, the Consensus Document from the European Leukemia Net MRD Working Party has recently recommended that NPM1-mutated AML patients have MRD assessment at informative clinical timepoints during treatment and follow-up. However, several controversies remain, mainly with regard to the most clinically significant timepoints and the MRD thresholds to be considered, but also with respect to the optimal source to be analyzed, namely bone marrow or peripheral blood samples, and the correlation of MRD with other known prognostic indicators. Moreover, we discuss potential advantages, as well as drawbacks, of newer molecular technologies such as digital droplet PCR and next-generation sequencing in comparison to conventional RQ-PCR to quantify NPM1-mutated MRD. In conclusion, further prospective clinical trials are warranted to standardize MRD monitoring strategies and to optimize MRD-guided therapeutic interventions in NPM1-mutated AML patients.
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The consensus on the monitoring, treatment, and prevention of leukemia relapse after allogeneic hematopoietic stem cell transplantation in China. Cancer Lett 2018; 438:63-75. [PMID: 30217562 DOI: 10.1016/j.canlet.2018.08.030] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 07/29/2018] [Accepted: 08/28/2018] [Indexed: 02/05/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an important curative therapy for patients with leukemia. However, relapse remains the leading cause of death after transplantation. In recent years, substantial progress has been made by Chinese physicians in the field of establishment of novel transplant modality, patient selection, minimal residual disease (MRD) monitoring, and immunological therapies, such as modified donor lymphocyte infusion (DLI) and chimeric antigen receptor T (CART) cells, as well as MRD-directed intervention for relapse. Most of these unique systems are distinct from those in the Western world. In this consensus, we reviewed the efficacy of post-HSCT relapse management practice from available Chinese studies on behalf of the HSCT workgroup of the Chinese Society of Hematology, Chinese Medical Association, and compared these studies withthe consensus or guidelines outside China. We summarized the consensus on routine practices of post-HSCT relapse management in China and focused on the recommendations of MRD monitoring, risk stratification directed strategies, and modified DLI system. This consensus will likely contribute to the standardization of post-HSCT relapse management in China and become an inspiration for further international cooperation to refine global practices.
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Selim AG, Moore AS. Molecular Minimal Residual Disease Monitoring in Acute Myeloid Leukemia. J Mol Diagn 2018; 20:389-397. [DOI: 10.1016/j.jmoldx.2018.03.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 02/22/2018] [Accepted: 03/27/2018] [Indexed: 01/22/2023] Open
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12
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Evaluating measurable residual disease in acute myeloid leukemia. Blood Adv 2018; 2:1356-1366. [PMID: 29895626 PMCID: PMC5998930 DOI: 10.1182/bloodadvances.2018016378] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/23/2018] [Indexed: 02/03/2023] Open
Abstract
Mounting evidence indicates that the presence of measurable ("minimal") residual disease (MRD), defined as posttherapy persistence of leukemic cells at levels below morphologic detection, is a strong, independent prognostic marker of increased risk of relapse and shorter survival in patients with acute myeloid leukemia (AML) and can be used to refine risk-stratification and treatment response assessment. Because of the association between MRD and relapse risk, it has been postulated that testing for MRD posttreatment may help guide postremission treatment strategies by identifying high-risk patients who might benefit from preemptive treatment. This strategy, which remains to be formally tested, may be particularly attractive with availability of agents that could be used to specifically eradicate MRD. This review examines current methods of MRD detection, challenges to adopting MRD testing in routine clinical practice, and recent recommendations for MRD testing in AML issued by the European LeukemiaNet MRD Working Party. Inclusion of MRD as an end point in future randomized clinical trials will provide the data needed to move toward standardizing MRD assays and may provide a more accurate assessment of therapeutic efficacy than current morphologic measures.
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13
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Walter RB, Appelbaum FR. Next-generation sequencing for measuring minimal residual disease in AML. Nat Rev Clin Oncol 2018; 15:473-474. [DOI: 10.1038/s41571-018-0040-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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14
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Coustan-Smith E, Song G, Shurtleff S, Yeoh AEJ, Chng WJ, Chen SP, Rubnitz JE, Pui CH, Downing JR, Campana D. Universal monitoring of minimal residual disease in acute myeloid leukemia. JCI Insight 2018; 3:98561. [PMID: 29720577 DOI: 10.1172/jci.insight.98561] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/28/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Optimal management of acute myeloid leukemia (AML) requires monitoring of treatment response, but minimal residual disease (MRD) may escape detection. We sought to identify distinctive features of AML cells for universal MRD monitoring. METHODS We compared genome-wide gene expression of AML cells from 157 patients with that of normal myeloblasts. Markers encoded by aberrantly expressed genes, including some previously associated with leukemia stem cells, were studied by flow cytometry in 240 patients with AML and in nonleukemic myeloblasts from 63 bone marrow samples. RESULTS Twenty-two (CD9, CD18, CD25, CD32, CD44, CD47, CD52, CD54, CD59, CD64, CD68, CD86, CD93, CD96, CD97, CD99, CD123, CD200, CD300a/c, CD366, CD371, and CX3CR1) markers were aberrantly expressed in AML. Leukemia-associated profiles defined by these markers extended to immature CD34+CD38- AML cells; expression remained stable during treatment. The markers yielded MRD measurements matching those of standard methods in 208 samples from 52 patients undergoing chemotherapy and revealed otherwise undetectable MRD. They allowed MRD monitoring in 129 consecutive patients, yielding prognostically significant results. Using a machine-learning algorithm to reduce high-dimensional data sets to 2-dimensional data, the markers allowed a clear visualization of MRD and could detect 1 leukemic cell among more than 100,000 normal cells. CONCLUSION The markers uncovered in this study allow universal and sensitive monitoring of MRD in AML. In combination with contemporary analytical tools, the markers improve the discrimination between leukemic and normal cells, thus facilitating data interpretation and, hence, the reliability of MRD results. FUNDING National Cancer Institute (CA60419 and CA21765); American Lebanese Syrian Associated Charities; National Medical Research Council of Singapore (1299/2011); Viva Foundation for Children with Cancer, Children's Cancer Foundation, Tote Board & Turf Club, and Lee Foundation of Singapore.
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Affiliation(s)
| | - Guangchun Song
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Sheila Shurtleff
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Allen Eng-Juh Yeoh
- Department of Pediatrics, National University of Singapore, Singapore.,National University Cancer Institute, Singapore, National University of Singapore, Singapore
| | - Wee Joo Chng
- National University Cancer Institute, Singapore, National University of Singapore, Singapore
| | - Siew Peng Chen
- Department of Pediatrics, National University of Singapore, Singapore
| | - Jeffrey E Rubnitz
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Ching-Hon Pui
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - James R Downing
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Dario Campana
- Department of Pediatrics, National University of Singapore, Singapore.,National University Cancer Institute, Singapore, National University of Singapore, Singapore
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15
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Coltoff A, Houldsworth J, Keyzner A, Renteria AS, Mascarenhas J. Role of minimal residual disease in the management of acute myeloid leukemia-a case-based discussion. Ann Hematol 2018; 97:1155-1167. [PMID: 29704019 DOI: 10.1007/s00277-018-3330-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 04/04/2018] [Indexed: 01/04/2023]
Abstract
AML is stratified into risk-categories based on cytogenetic and molecular features that prognosticate survival and facilitate treatment algorithms, though there is still significant heterogeneity within risk groupings with regard to risk of relapse and prognosis. The ambiguity regarding prognosis is due in large part to the relatively outdated criteria used to determine response to therapy. Whereas risk assessment has evolved to adopt cytogenetic and molecular profiling, response criteria are still largely determined by bone marrow morphologic assessment and peripheral cell count recovery. Minimal residual disease refers to the detection of a persistent population of leukemic cells below the threshold for morphologic CR determination. MRD assessment represents standard of care for ALL and PML, but concerns over prognostic capability and standardization have limited its use in AML. However, recent advancements in MRD assessment and research supporting the use of MRD assessment in AML require the reconsideration and review of this clinical tool in this disease entity. This review article will first compare and contrast the major modalities used to assess MRD in AML, such as RQ-PCR and flow cytometry, as well as touching upon newer technologies such as next-generation sequencing and digital droplet PCR. The majority of the article will discuss the evidence supporting the use of MRD assessment to prognosticate disease at various time points during treatment, and review the limited number of studies that have incorporated MRD assessment into novel treatment algorithms for AML. The article concludes by discussing the current major limitations to the implementation of MRD assessment in this disease. The manuscript is bookended by a clinical vignette that highlights the need for further research and refinement of this clinical tool.
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Affiliation(s)
- A Coltoff
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Houldsworth
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Keyzner
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A S Renteria
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John Mascarenhas
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Adult Leukemia Program, Myeloproliferative Disorders Clinical Research Program, Tisch Cancer Institute, Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1079, New York, NY, 10029, USA.
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16
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Abstract
Therapeutics that block kinases, transcriptional modifiers, immune checkpoints and other biological vulnerabilities are transforming cancer treatment. As a result, many patients achieve dramatic responses, including complete radiographical or pathological remission, yet retain minimal residual disease (MRD), which results in relapse. New functional approaches can characterize clonal heterogeneity and predict therapeutic sensitivity of MRD at a single-cell level. Preliminary evidence suggests that iterative detection, profiling and targeting of MRD would meaningfully improve outcomes and may even lead to cure.
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Affiliation(s)
- Marlise R. Luskin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA,
| | - Mark A. Murakami
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA,
| | - Scott R. Manalis
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA
- Corresponding authors: (S. R. M.) and (D. M. W.)
| | - David M. Weinstock
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA,
- Broad Institute of MIT and Harvard University, Cambridge, Massachusetts, 02142, USA
- Corresponding authors: (S. R. M.) and (D. M. W.)
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17
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Sweet K, Lancet J. State of the Art Update and Next Questions: Acute Myeloid Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:703-709. [PMID: 29110833 DOI: 10.1016/j.clml.2017.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 01/02/2023]
Abstract
As our general understanding regarding the complex nature of acute myeloid leukemia (AML) is expanding, so is our ability to translate this biological data into clinically relevant information. The use of whole genome and whole exome sequencing has begun to shed light on the importance of a variety of somatic mutations that are frequently identified in AML. In turn, this has allowed the field to incorporate mutational data into prognostic classifications which can guide treatment decisions. Furthermore, minimal residual disease (MRD) monitoring in AML is more commonplace as the prognostic relevance of MRD at various time points during treat is becoming clear. Many novel treatments have recently been approved, or are expected to gain approval in the near future, and this is opening the door to a more personalized approach to the management of AML.
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18
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Yu FF, Bai YN, He H, Zhu L, Zhang RL, Jiao HX, Li QY, Fu JF. Identifying the unmet supportive care needs, with concomitant influencing factors, in adult acute leukemia patients in China. Eur J Oncol Nurs 2017; 30:67-74. [DOI: 10.1016/j.ejon.2017.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 02/17/2017] [Accepted: 07/03/2017] [Indexed: 12/26/2022]
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19
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Lin S, Mulloy JC, Goyama S. RUNX1-ETO Leukemia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 962:151-173. [PMID: 28299657 DOI: 10.1007/978-981-10-3233-2_11] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AML1-ETO leukemia is the most common cytogenetic subtype of acute myeloid leukemia, defined by the presence of t(8;21). Remarkable progress has been achieved in understanding the molecular pathogenesis of AML1-ETO leukemia. Proteomic surveies have shown that AML-ETO forms a stable complex with several transcription factors, including E proteins. Genome-wide transcriptome and ChIP-seq analyses have revealed the genes directly regulated by AML1-ETO, such as CEBPA. Several lines of evidence suggest that AML1-ETO suppresses endogenous DNA repair in cells to promote mutagenesis, which facilitates acquisition of cooperating secondary events. Furthermore, it has become increasingly apparent that a delicate balance of AML1-ETO and native AML1 is important to sustain the malignant cell phenotype. Translation of these findings into the clinical setting is just beginning.
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Affiliation(s)
- Shan Lin
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - James C Mulloy
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Susumu Goyama
- Division of Cellular Therapy, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
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20
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Luskin MR, Stone RM. Can Minimal Residual Disease Determination in Acute Myeloid Leukemia Be Used in Clinical Practice? J Oncol Pract 2017; 13:471-480. [DOI: 10.1200/jop.2017.021675] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
In acute myeloid leukemia (AML) that is in complete remission, minimal residual disease (MRD) is presumed to be present, though not morphologically evident. Advances in diagnostics now permit the detection and quantification of MRD in AML by several techniques. The level of MRD after induction and consolidation therapy correlates with disease sensitivity to chemotherapy and has greater power to predict long-term survival than patient and disease characteristics that are available at diagnosis, including genetic information. A unique advantage of MRD is that it is an integrated measure of the impact and interaction of genetics, epigenetics, host immune milieu, bone marrow environment, and drug sensitivity on disease response to treatment. Here, we review the main techniques for MRD assessment in AML, including polymerase chain reaction, multiparameter flow cytometry, and next-generation sequencing, with a focus on method-specific and general limitations to the optimal employment of MRD techniques for the determination of AML prognosis. We also review the data that establish the prognostic and predictive value of MRD assessment in AML. Finally, we provide recommendations for the use of MRD in the care of patients with AML in clinical practice today, including whether it should influence treatment decisions.
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Affiliation(s)
- Marlise R. Luskin
- Dana-Farber Cancer Institute; and Harvard Medical School, Boston, MA
| | - Richard M. Stone
- Dana-Farber Cancer Institute; and Harvard Medical School, Boston, MA
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21
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Therapeutic targeting of acute myeloid leukemia stem cells. Blood 2017; 129:1627-1635. [PMID: 28159738 DOI: 10.1182/blood-2016-10-696039] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 11/27/2016] [Indexed: 12/12/2022] Open
Abstract
For more than 50 years, investigators have considered a malignant stem cell as the potential origin of and a key therapeutic target for acute myeloid leukemia (AML) and other forms of cancer.1-4 The nature and existence of tumor-initiating cells for leukemia and other malignancies have long been the subject of intense and rigorous study; indeed, the promise of the potential to eradicate such cells is clear. However, until recently, deficiencies in our understanding of the nature of these cell populations, coupled with a limited ability to therapeutically exploit their weaknesses, have been limiting factors in realizing the goal of targeting leukemic stem cells (LSCs). Exciting new insights into the fundamental underpinnings of LSCs are now being made in an era in which drug development pipelines offer the potential to specifically target pathways of significance. Therefore, the focus in this new era, characterized by the confluence of understanding LSCs and the ability to target them, is shifting from "if it can be done" to "how it will be done." Moving from a theoretical stage to this hopeful era of possibilities, new challenges expectedly arise, and our focus now must shift to determining the best strategy by which to target LSCs, with their well-documented heterogeneity and readily evident intra- and interpatient variability. The purpose of this review is therefore both to summarize the key scientific findings pertinent to AML LSC targeting and to consider methods of clinical evaluation that will be most effective for identifying successful LSC-directed therapies.
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22
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Zhu HH, Huang XJ. [How I treat acute myeloid leukemia with t (8;21)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2017; 38:6-9. [PMID: 28219217 PMCID: PMC7348410 DOI: 10.3760/cma.j.issn.0253-2727.2017.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Indexed: 11/24/2022]
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23
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Frontline treatment of acute myeloid leukemia in adults. Crit Rev Oncol Hematol 2016; 110:20-34. [PMID: 28109402 DOI: 10.1016/j.critrevonc.2016.12.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 11/01/2016] [Accepted: 12/07/2016] [Indexed: 01/13/2023] Open
Abstract
Recent years have highlighted significant progress in understanding the underlying genetic and epigenetic signatures of acute myeloid leukemia(AML). Most importantly, novel chemotherapy and targeted strategies have led to improved outcomes in selected genetic subsets. AML is a remarkably heterogeneous disease, and individualized therapies for disease-specific characteristics (considering patients' age, cytogenetics, and mutations) could yield better outcomes. Compared with the historical 5-to 10-year survival rate of 10%, the survival of patients who undergo modern treatment approaches reaches up to 40-50%, and for specific subsets, the improvements are even more dramatic; for example, in acute promyelocytic leukemia, the use of all-trans retinoic acid and arsenic trioxide improved survival from 30 to 40% up to 80 to 90%. Similar progress has been documented in core-binding-factor-AML, with an increase in survival from 30% to 80% upon the use of high-dose cytarabine/fludarabine/granulocyte colony-stimulating factor combination regimens. AML treatment was also recently influenced by the discovery of the superiority of regimens with higher dose Ara-C and nucleoside analogues compared with the "7+3"regimen, with about a 20% improvement in overall survival. Despite these significant differences, most centers continue to use the "7+3" regimen, and greater awareness will improve the outcome. The discovery of targetable molecular abnormalities and recent studies of targeted therapies (gemtuzumab ozagomycin, FLT3 inhibitors, isocitrate dehydrogenase inhibitors, and epigenetic therapies), future use of checkpoint inhibitors and other immune therapies such as chimeric antigen receptor T-cells, and maintenance strategies based on the minimal residual disease evaluation represent novel, exciting clinical leads aimed to improve AML outcomes in the near future.
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24
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Rashidi A, Walter RB, Tallman MS, Appelbaum FR, DiPersio JF. Maintenance therapy in acute myeloid leukemia: an evidence-based review of randomized trials. Blood 2016; 128:763-73. [PMID: 27354720 PMCID: PMC4982451 DOI: 10.1182/blood-2016-03-674127] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/20/2016] [Indexed: 11/20/2022] Open
Affiliation(s)
- Armin Rashidi
- Section of Bone Marrow Transplantation and Leukemia Program, Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Roland B Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Hematology, Department of Medicine, and Department of Epidemiology, University of Washington, Seattle, WA
| | - Martin S Tallman
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY; and
| | - Frederick R Appelbaum
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - John F DiPersio
- Section of Bone Marrow Transplantation and Leukemia Program, Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
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25
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Manara E, Basso G, Zampini M, Buldini B, Tregnago C, Rondelli R, Masetti R, Bisio V, Frison M, Polato K, Cazzaniga G, Menna G, Fagioli F, Merli P, Biondi A, Pession A, Locatelli F, Pigazzi M. Characterization of children with FLT3-ITD acute myeloid leukemia: a report from the AIEOP AML-2002 study group. Leukemia 2016; 31:18-25. [PMID: 27416911 DOI: 10.1038/leu.2016.177] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/30/2016] [Accepted: 06/03/2016] [Indexed: 01/02/2023]
Abstract
Recurrent molecular markers have been routinely used in acute myeloid leukemia (AML) for risk assessment at diagnosis, whereas their post-induction monitoring still represents a debated issue. We evaluated the prognostic value and biological impact of minimal residual disease (MRD) and of the allelic ratio (AR) of FLT3-internal-tandem duplication (ITD) in childhood AML. We retrospectively screened 494 children with de novo AML for FLT3-ITD mutation, identifying 54 harboring the mutation; 51% of them presented high ITD-AR at diagnosis and had worse event-free survival (EFS, 19.2 versus 63.5% for low ITD-AR, <0.05). Forty-one percent of children with high levels of MRD after the 1st induction course, measured by a patient-specific real-time-PCR, had worse EFS (22.2 versus 59.4% in low-MRD patients, P<0.05). Next, we correlated these parameters with gene expression, showing that patients with high ITD-AR or persistent MRD had characteristic expression profiles with deregulated genes involved in methylation and acetylation. Moreover, patients with high CyclinA1 expression presented an unfavorable EFS (20.3 versus 51.2% in low CyclinA1 group, P<0.01). Our results suggest that ITD-AR levels and molecular MRD should be considered in planning clinical management of FLT3-ITD patients. Different transcriptional activation of epigenetic and oncogenic profiles may explain variability in outcome among these patients, for whom novel therapeutic approaches are desirable.
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Affiliation(s)
- E Manara
- Istituto di Ricerca Pediatrica - Città della Speranza, Padova, Italy
| | - G Basso
- Dipartimento di Salute della Donna e del Bambino, Clinica di Oncoematologia Pediatrica, Università di Padova, Padova, Italy
| | - M Zampini
- Istituto di Ricerca Pediatrica - Città della Speranza, Padova, Italy
| | - B Buldini
- Dipartimento di Salute della Donna e del Bambino, Clinica di Oncoematologia Pediatrica, Università di Padova, Padova, Italy
| | - C Tregnago
- Dipartimento di Salute della Donna e del Bambino, Clinica di Oncoematologia Pediatrica, Università di Padova, Padova, Italy
| | - R Rondelli
- Clinica Pediatrica, Università di Bologna, Ospedale 'S. Orsola', Bologna, Italy
| | - R Masetti
- Clinica Pediatrica, Università di Bologna, Ospedale 'S. Orsola', Bologna, Italy
| | - V Bisio
- Dipartimento di Salute della Donna e del Bambino, Clinica di Oncoematologia Pediatrica, Università di Padova, Padova, Italy
| | - M Frison
- Dipartimento di Salute della Donna e del Bambino, Clinica di Oncoematologia Pediatrica, Università di Padova, Padova, Italy
| | - K Polato
- Dipartimento di Salute della Donna e del Bambino, Clinica di Oncoematologia Pediatrica, Università di Padova, Padova, Italy
| | - G Cazzaniga
- Clinica Pediatrica, Centro Ricerca Tettamanti, Università di Milano-Bicocca, Monza, Italia
| | - G Menna
- Department of Paediatric Haemato-Oncology, Santobono-Pausilipon Hospital, Napoli, Italy
| | - F Fagioli
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Italy
| | - P Merli
- IRCCS Bambino Gesù Children's Hospital Rome, Università di Pavia, Rome, Italy
| | - A Biondi
- Clinica Pediatrica, Centro Ricerca Tettamanti, Università di Milano-Bicocca, Monza, Italia
| | - A Pession
- Clinica Pediatrica, Università di Bologna, Ospedale 'S. Orsola', Bologna, Italy
| | - F Locatelli
- IRCCS Bambino Gesù Children's Hospital Rome, Università di Pavia, Rome, Italy
| | - M Pigazzi
- Dipartimento di Salute della Donna e del Bambino, Clinica di Oncoematologia Pediatrica, Università di Padova, Padova, Italy
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26
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Cao YG, Jiang EL, He Y, Wei JL, Zhang RL, Huang Y, Yang DL, Ma QL, Feng SZ, Han MZ. [Analyses of outcome and prognostic factors of adult acute myeloid leukemia patients received autologous hematopoietic stem cell transplantation]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:464-8. [PMID: 27431069 PMCID: PMC7348336 DOI: 10.3760/cma.j.issn.0253-2727.2016.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate the outcome of patients with acute myeloid leukemia (AML) received autologous hematopoietic stem cell transplantation (APBSCT) in complete remission (CR), and to study the prognostic factors. METHODS 55 cases of AML who underwent APBSCT in CR between 2008 and 2014 were retrospectively investigated. Major end points of study included overall survival (OS), disease free survival (DFS), relapse rate and transplantation related mortality. RESULTS The median follow-up time was 1 091(20-3 024) days after transplantation. The 3-year OS and DFS rates were 77.1% (95%CI 71.2%-83.8%), 73.7% (95%CI 67.2%-80.3%), respectively. 3-year DFS for patients needed less than 200 days to attain minimal residual disease (MRD) ≤0.03% was significantly higher than that of patients required 200 days or more (88.9% vs 46.9%, P=0.042). 3-year DFS for patients with constant MRD negative 90.0% was greater than that of the remaining group 61.1% , but the difference was insignificant (P=0.090). A multivariate analysis of risk factors for relapse identified days from diagnosis to MRD negative was the only independent factor [RR=0.022 (95% CI 0.001-0.604), P=0.024]. CONCLUSION The results suggested that most AML patients in CR obtained long-term DFS after APBSCT, and continuous monitoring minimal residual disease could be used to evaluate whether adult AML patients should receive APBSCT or not.
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Affiliation(s)
- Y G Cao
- Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
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27
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Pettit K, Stock W, Walter RB. Incorporating measurable ('minimal') residual disease-directed treatment strategies to optimize outcomes in adults with acute myeloid leukemia. Leuk Lymphoma 2016; 57:1527-33. [PMID: 27269126 DOI: 10.3109/10428194.2016.1160085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Curative-intent therapy leads to complete remissions in many adults with acute myeloid leukemia (AML), but relapse remains common. Numerous studies have unequivocally demonstrated that the persistence of measurable ('minimal') residual disease (MRD) at the submicroscopic level during morphologic remission identifies patients at high risk of disease recurrence and short survival. This association has provided the impetus to customize anti-leukemia therapy based on MRD data, a strategy that is now routinely pursued in acute promyelocytic leukemia (APL). While it is currently uncertain whether this approach will improve outcomes in AML other than APL, randomized studies have validated MRD-based risk-stratified treatment algorithms in acute lymphoblastic leukemia. Here, we review the available studies examining MRD-directed therapy in AML, appraise their strengths and limitations, and discuss avenues for future investigation.
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Affiliation(s)
- Kristen Pettit
- a Section of Hematology/Oncology and University of Chicago Comprehensive Cancer Center , University of Chicago , Chicago , IL , USA
| | - Wendy Stock
- a Section of Hematology/Oncology and University of Chicago Comprehensive Cancer Center , University of Chicago , Chicago , IL , USA
| | - Roland B Walter
- b Clinical Research Division , Fred Hutchinson Cancer Research Center , Seattle , WA , USA ;,c Department of Medicine, Division of Hematology , University of Washington , Seattle , WA , USA ;,d Department of Epidemiology , University of Washington , Seattle , WA , USA
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Ouyang J, Goswami M, Peng J, Zuo Z, Daver N, Borthakur G, Tang G, Medeiros LJ, Jorgensen JL, Ravandi F, Wang SA. Comparison of Multiparameter Flow Cytometry Immunophenotypic Analysis and Quantitative RT-PCR for the Detection of Minimal Residual Disease of Core Binding Factor Acute Myeloid Leukemia. Am J Clin Pathol 2016; 145:769-77. [PMID: 27298396 DOI: 10.1093/ajcp/aqw038] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To examine the value of minimal residual disease (MRD) by multiparameter flow cytometry (MFC) in core binding factor (CBF) acute myeloid leukemia (AML). METHODS We studied 42 patients with t(8;21)(q22;q22)/RUNX1-RUNX1T1 and 51 with inv(16)(p13.1q22)/CBFB-MYH11 Tandem MRD analyses by MFC and quantitative reverse transcription polymerase chain reaction (qRT-PCR) were performed in 281 bone marrow (BM) samples. RESULTS Grouping qRT-PCR levels as ≤0.01, 0.01 to 0.1, 0.1 to 1, 1 to 10, and >10%, and reporting MFC (sensitivity, 0.1%-0.01%) as positive or negative, κ coefficient test showed no agreement between qRT-PCR and MFC in BM samples obtained postinduction (n = 44, κ = 0.041), and only weak agreement during consolidation (n = 108, κ = 0.083), maintenance/follow-up (n = 107, κ = 0.164), and salvage chemotherapy (n = 24, 0.376). In the post induction BM samples, while qRT-PCR <0.1% was associated with lower and ≥10% with higher AML relapse risk (P = .035), qRT-PCR between 0.1% to 1% and 1% to 10% failed to predict relapse. In the latter group with intermediate qRT-PCR results, MFC provided prognostic value for relapse (P = 0.006). CONCLUSIONS MFC and qRT-PCR are complementary tests in monitoring CBF AML MRD.
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Affiliation(s)
| | | | - Jie Peng
- From the Departments of Hematopathology
| | | | - Naval Daver
- Leukemia, The University of Texas MD Anderson Cancer Center, Houston
| | - Gautam Borthakur
- Leukemia, The University of Texas MD Anderson Cancer Center, Houston
| | | | | | | | - Farhad Ravandi
- Leukemia, The University of Texas MD Anderson Cancer Center, Houston
| | - Sa A Wang
- From the Departments of Hematopathology
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29
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Hourigan CS, Goswami M, Battiwalla M, Barrett AJ, Sheela S, Karp JE, Lai C. When the Minimal Becomes Measurable. J Clin Oncol 2016; 34:2557-8. [PMID: 27185839 DOI: 10.1200/jco.2016.67.6395] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Meghali Goswami
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Minoo Battiwalla
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Austin J Barrett
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Sheenu Sheela
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Judith E Karp
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Catherine Lai
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
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30
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Khwaja A, Bjorkholm M, Gale RE, Levine RL, Jordan CT, Ehninger G, Bloomfield CD, Estey E, Burnett A, Cornelissen JJ, Scheinberg DA, Bouscary D, Linch DC. Acute myeloid leukaemia. Nat Rev Dis Primers 2016; 2:16010. [PMID: 27159408 DOI: 10.1038/nrdp.2016.10] [Citation(s) in RCA: 225] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Acute myeloid leukaemia (AML) is a disorder characterized by a clonal proliferation derived from primitive haematopoietic stem cells or progenitor cells. Abnormal differentiation of myeloid cells results in a high level of immature malignant cells and fewer differentiated red blood cells, platelets and white blood cells. The disease occurs at all ages, but predominantly occurs in older people (>60 years of age). AML typically presents with a rapid onset of symptoms that are attributable to bone marrow failure and may be fatal within weeks or months when left untreated. The genomic landscape of AML has been determined and genetic instability is infrequent with a relatively small number of driver mutations. Mutations in genes involved in epigenetic regulation are common and are early events in leukaemogenesis. The subclassification of AML has been dependent on the morphology and cytogenetics of blood and bone marrow cells, but specific mutational analysis is now being incorporated. Improvements in treatment in younger patients over the past 35 years has largely been due to dose escalation and better supportive care. Allogeneic haematopoietic stem cell transplantation may be used to consolidate remission in those patients who are deemed to be at high risk of relapse. A plethora of new agents - including those targeted at specific biochemical pathways and immunotherapeutic approaches - are now in trial based on improved understanding of disease pathophysiology. These advances provide good grounds for optimism, although mortality remains high especially in older patients.
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Affiliation(s)
- Asim Khwaja
- Department of Haematology, University College London, UCL Cancer Institute, 72 Huntley Street, London WC1E 6DD, UK
| | - Magnus Bjorkholm
- Department of Medicine, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Rosemary E Gale
- Department of Haematology, University College London, UCL Cancer Institute, 72 Huntley Street, London WC1E 6DD, UK
| | - Ross L Levine
- Human Oncology and Pathogenesis Program, Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Craig T Jordan
- Division of Hematology, University of Colorado Denver, Denver, Colorado, USA
| | - Gerhard Ehninger
- Department of Internal Medicine, Technical University Dresden, Dresden, Germany
| | | | - Eli Estey
- Division of Hematology, University of Washington and Clinical Research Division Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | | | - David A Scheinberg
- Molecular Pharmacology Program, Experimental Therapeutics Center, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Didier Bouscary
- Institut Cochin, Département Développement Reproduction Cancer, CNRS UMR8104, INSERM U1016, Paris, France.,Service d'Hématologie, Hôpital Cochin, AP-HP, Paris, France.,Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France
| | - David C Linch
- Department of Haematology, University College London, UCL Cancer Institute, 72 Huntley Street, London WC1E 6DD, UK
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31
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Should acute myeloid leukemia patients with actionable targets be offered investigational treatment after failing one cycle of standard induction therapy? Curr Opin Hematol 2016; 23:102-7. [PMID: 26766538 DOI: 10.1097/moh.0000000000000213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Therapeutic failure in acute myeloid leukemia remains common. It may be advantageous to identify patients with suboptimal treatment responses early as they may benefit from timely care strategy changes. Here, responses portending failure of standard induction therapy are reviewed and therapeutic options examined, including use of investigational, targeted agents for suitable patients. RECENT FINDINGS Patients entering complete remission without minimal residual disease early, that is, with one cycle of standard induction chemotherapy, have a lower relapse risk and live longer than other similarly-treated patients, supporting the proposition of early complete remission without minimal residual disease as a criterion for induction therapy success. Investigational small molecule drugs are appealing for patients who fail standard therapies, but complete remission rates as a single agent are typically modest. SUMMARY The relative value of different treatment strategies if a first standard induction therapy cycle fails to produce complete remission is unknown. However, retreatment with the same therapy often leads to complete remission and provides a benchmark against which other approaches should be compared. Addition of investigational small molecule drugs to standard reinduction therapy in patients with actionable targets could offer an attractive therapeutic strategy in this situation that might improve outcomes and facilitate clinical drug testing.
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32
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Kantarjian H. Acute myeloid leukemia--major progress over four decades and glimpses into the future. Am J Hematol 2016; 91:131-45. [PMID: 26598393 DOI: 10.1002/ajh.24246] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 11/18/2015] [Indexed: 12/17/2022]
Abstract
In this Review, the progress in research and therapy of acute myeloid leukemia is detailed.
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Affiliation(s)
- Hagop Kantarjian
- Department of Leukemia; MD Anderson Cancer Center; Houston Texas
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33
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Araki D, Wood BL, Othus M, Radich JP, Halpern AB, Zhou Y, Mielcarek M, Estey EH, Appelbaum FR, Walter RB. Allogeneic Hematopoietic Cell Transplantation for Acute Myeloid Leukemia: Time to Move Toward a Minimal Residual Disease-Based Definition of Complete Remission? J Clin Oncol 2015; 34:329-36. [PMID: 26668349 DOI: 10.1200/jco.2015.63.3826] [Citation(s) in RCA: 316] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients with acute myeloid leukemia (AML) who are in morphologic complete remission are typically considered separately from patients with active disease (ie, ≥ 5% marrow blasts by morphology) in treatment algorithms for allogeneic hematopoietic cell transplantation (HCT), which implies distinct outcomes for these two groups. It is well recognized that the presence of minimal residual disease (MRD) at the time of transplantation is associated with adverse post-HCT outcome for those patients in morphologic remission. This effect of pre-HCT MRD prompted us to compare outcomes in consecutive patients in MRD-positive remission with patients with active AML who underwent myeloablative allogeneic HCT at our institution. PATIENTS AND METHODS We retrospectively studied 359 consecutive adults with AML who underwent myeloablative allogeneic HCT from a peripheral blood or bone marrow donor between 2006 and 2014. Pre-HCT disease staging included 10-color multiparametric flow cytometry on bone marrow aspirates in all patients. Any level of residual disease was considered to be MRD positive. RESULTS Three-year relapse estimates were 67% in 76 patients in MRD-positive morphologic remission and 65% in 48 patients with active AML compared with 22% in 235 patients in MRD-negative remission. Three-year overall survival estimates were 26%, 23%, and 73% in these three groups, respectively. After multivariable adjustment, MRD-negative remission status remained statistically significantly associated with longer overall and progression-free survival as well as lower risk of relapse compared with MRD-positive morphologic remission status or having active disease, with similar outcomes between the latter two groups. CONCLUSION The similarities in outcomes between patients in MRD-positive morphologic remission and those with active disease at the time of HCT support the use of treatment algorithms that use MRD- rather than morphology-based disease assessments.
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Affiliation(s)
- Daisuke Araki
- Daisuke Araki, Brent L. Wood, Jerald P. Radich, Anna B. Halpern, Yi Zhou, Marco Mielcarek, Elihu H. Estey, Frederick R. Appelbaum, and Roland B. Walter, University of Washington; and Megan Othus, Jerald P. Radich, Marco Mielcarek, Elihu H. Estey, Frederick R. Appelbaum, and Roland B. Walter, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Brent L Wood
- Daisuke Araki, Brent L. Wood, Jerald P. Radich, Anna B. Halpern, Yi Zhou, Marco Mielcarek, Elihu H. Estey, Frederick R. Appelbaum, and Roland B. Walter, University of Washington; and Megan Othus, Jerald P. Radich, Marco Mielcarek, Elihu H. Estey, Frederick R. Appelbaum, and Roland B. Walter, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Megan Othus
- Daisuke Araki, Brent L. Wood, Jerald P. Radich, Anna B. Halpern, Yi Zhou, Marco Mielcarek, Elihu H. Estey, Frederick R. Appelbaum, and Roland B. Walter, University of Washington; and Megan Othus, Jerald P. Radich, Marco Mielcarek, Elihu H. Estey, Frederick R. Appelbaum, and Roland B. Walter, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jerald P Radich
- Daisuke Araki, Brent L. Wood, Jerald P. Radich, Anna B. Halpern, Yi Zhou, Marco Mielcarek, Elihu H. Estey, Frederick R. Appelbaum, and Roland B. Walter, University of Washington; and Megan Othus, Jerald P. Radich, Marco Mielcarek, Elihu H. Estey, Frederick R. Appelbaum, and Roland B. Walter, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Anna B Halpern
- Daisuke Araki, Brent L. Wood, Jerald P. Radich, Anna B. Halpern, Yi Zhou, Marco Mielcarek, Elihu H. Estey, Frederick R. Appelbaum, and Roland B. Walter, University of Washington; and Megan Othus, Jerald P. Radich, Marco Mielcarek, Elihu H. Estey, Frederick R. Appelbaum, and Roland B. Walter, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Yi Zhou
- Daisuke Araki, Brent L. Wood, Jerald P. Radich, Anna B. Halpern, Yi Zhou, Marco Mielcarek, Elihu H. Estey, Frederick R. Appelbaum, and Roland B. Walter, University of Washington; and Megan Othus, Jerald P. Radich, Marco Mielcarek, Elihu H. Estey, Frederick R. Appelbaum, and Roland B. Walter, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Marco Mielcarek
- Daisuke Araki, Brent L. Wood, Jerald P. Radich, Anna B. Halpern, Yi Zhou, Marco Mielcarek, Elihu H. Estey, Frederick R. Appelbaum, and Roland B. Walter, University of Washington; and Megan Othus, Jerald P. Radich, Marco Mielcarek, Elihu H. Estey, Frederick R. Appelbaum, and Roland B. Walter, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Elihu H Estey
- Daisuke Araki, Brent L. Wood, Jerald P. Radich, Anna B. Halpern, Yi Zhou, Marco Mielcarek, Elihu H. Estey, Frederick R. Appelbaum, and Roland B. Walter, University of Washington; and Megan Othus, Jerald P. Radich, Marco Mielcarek, Elihu H. Estey, Frederick R. Appelbaum, and Roland B. Walter, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Frederick R Appelbaum
- Daisuke Araki, Brent L. Wood, Jerald P. Radich, Anna B. Halpern, Yi Zhou, Marco Mielcarek, Elihu H. Estey, Frederick R. Appelbaum, and Roland B. Walter, University of Washington; and Megan Othus, Jerald P. Radich, Marco Mielcarek, Elihu H. Estey, Frederick R. Appelbaum, and Roland B. Walter, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Roland B Walter
- Daisuke Araki, Brent L. Wood, Jerald P. Radich, Anna B. Halpern, Yi Zhou, Marco Mielcarek, Elihu H. Estey, Frederick R. Appelbaum, and Roland B. Walter, University of Washington; and Megan Othus, Jerald P. Radich, Marco Mielcarek, Elihu H. Estey, Frederick R. Appelbaum, and Roland B. Walter, Fred Hutchinson Cancer Research Center, Seattle, WA.
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34
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Hokland P, Ommen HB, Mulé MP, Hourigan CS. Advancing the Minimal Residual Disease Concept in Acute Myeloid Leukemia. Semin Hematol 2015; 52:184-92. [PMID: 26111465 DOI: 10.1053/j.seminhematol.2015.04.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The criteria to evaluate response to treatment in acute myeloid leukemia (AML) have changed little in the past 60 years. It is now possible to use higher sensitivity tools to measure residual disease burden in AML. Such minimal or measurable residual disease (MRD) measurements provide a deeper understanding of current patient status and allow stratification for risk of subsequent clinical relapse. Despite these obvious advantages, and after over a decade of laboratory investigation and preclinical validation, MRD measurements are not currently routinely used for clinical decision-making or drug development in non-acute promyelocytic leukemia (non-APL) AML. We review here some potential constraints that may have delayed adoption, including a natural hesitancy of end users, economic impact concerns, misperceptions regarding the meaning of and need for assay sensitivity, the lack of one single MRD solution for all AML patients, and finally the need to involve patients in decision-making based on such correlates. It is our opinion that none of these issues represent insurmountable barriers and our hope is that by providing potential solutions we can help map a path forward to a future where our patients will be offered personalized treatment plans based on the amount of AML they have left remaining to treat.
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Affiliation(s)
- Peter Hokland
- Department of Hematology, Aarhus University Hospital, Denmark
| | - Hans B Ommen
- Department of Hematology, Aarhus University Hospital, Denmark
| | - Matthew P Mulé
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Christopher S Hourigan
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD.
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