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Ihlow J, Gross S, Busack L, Flörcken A, Jesse J, Schwarz M, Neuendorff NR, Brünneck ACV, Anagnostopoulos I, Türkmen S, Blau IW, Burmeister T, Horst D, Bullinger L, Westermann J. Acute myeloid leukemia: negative prognostic impact of early blast persistence can be in part overcome by a later remission prior to post-induction therapy. Haematologica 2022; 107:1773-1785. [PMID: 34758607 PMCID: PMC9335105 DOI: 10.3324/haematol.2021.279134] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 10/07/2021] [Indexed: 11/09/2022] Open
Abstract
In acute myeloid leukemia, there is an ongoing debate on the prognostic value of the early bone marrow assessment in patients receiving intensive therapy. In this retrospective study, we analyzed the prognostic impact of the early response in 1,008 patients with newly diagnosed acute myeloid leukemia, who were treated at our institution with intensive chemotherapy followed by consolidation chemotherapy and/or allogeneic hematopoietic stem cell transplantation (HSCT). We found that early blast persistence has an independent negative prognostic impact on overall survival, eventfree survival and relapse-free survival. This negative prognostic impact may only be overcome in patients showing at least a partial remission at the early bone marrow assessment and who subsequently achieve blast clearance by additional induction chemotherapy prior to consolidation therapy with allogeneic HSCT. In accordance, we propose that the time slope of remission is an additional leukemia-related dynamic parameter that reflects chemosensitivity and thus may inform post-induction therapy decision-making. In addition to patient-related factors, European LeukemiaNet risk group, measurable residual disease monitoring and donor availability, this may particularly apply to European LeukemiaNet intermediate-risk patients, for whom a decision between consolidation chemotherapy and allogeneic HSCT remains challenging in many cases.
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Affiliation(s)
- Jana Ihlow
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology and Tumor Immunology, Campus Virchow Clinic, Augustenburger Platz 1, 13353 Berlin, Germany; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin
| | - Sophia Gross
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology and Tumor Immunology, Campus Virchow Clinic, Augustenburger Platz 1, 13353 Berlin
| | - Leonie Busack
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology and Tumor Immunology, Campus Virchow Clinic, Augustenburger Platz 1, 13353 Berlin
| | - Anne Flörcken
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology and Tumor Immunology, Campus Virchow Clinic, Augustenburger Platz 1, 13353 Berlin, Germany; Labor Berlin Charité Vivantes GmbH, Sylter Straße 2, 13353 Berlin
| | - Julia Jesse
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology and Tumor Immunology, Campus Virchow Clinic, Augustenburger Platz 1, 13353 Berlin
| | - Michaela Schwarz
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology and Tumor Immunology, Campus Virchow Clinic, Augustenburger Platz 1, 13353 Berlin
| | - Nina Rosa Neuendorff
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology and Tumor Immunology, Campus Virchow Clinic, Augustenburger Platz 1, 13353 Berlin
| | - Ann-Christin von Brünneck
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin
| | - Ioannis Anagnostopoulos
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin
| | - Seval Türkmen
- Labor Berlin Charité Vivantes GmbH, Sylter Straße 2, 13353 Berlin, Germany; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Medical Genetics and Human Genetics, Augustenburger Platz 1, 13353 Berlin
| | - Igor Wolfgang Blau
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology and Tumor Immunology, Campus Virchow Clinic, Augustenburger Platz 1, 13353 Berlin, Germany; Labor Berlin Charité Vivantes GmbH, Sylter Straße 2, 13353 Berlin
| | - Thomas Burmeister
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology and Tumor Immunology, Campus Virchow Clinic, Augustenburger Platz 1, 13353 Berlin, Germany; Labor Berlin Charité Vivantes GmbH, Sylter Straße 2, 13353 Berlin
| | - David Horst
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin
| | - Lars Bullinger
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology and Tumor Immunology, Campus Virchow Clinic, Augustenburger Platz 1, 13353 Berlin, Germany; Labor Berlin Charité Vivantes GmbH, Sylter Straße 2, 13353 Berlin
| | - Jörg Westermann
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology and Tumor Immunology, Campus Virchow Clinic, Augustenburger Platz 1, 13353 Berlin, Germany; Labor Berlin Charité Vivantes GmbH, Sylter Straße 2, 13353 Berlin.
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