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Yegin ZA, Dikyar A, Aydın Kaynar L, Can F, Özkurt ZN, Yağcı M. Comparison of post-remission strategies in acute myeloid leukemia: Autologous hematopoietic stem cell transplantation versus consolidation chemotherapy. Hematol Rep 2020; 12:8380. [PMID: 33324478 PMCID: PMC7731661 DOI: 10.4081/hr.2020.8380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 07/10/2020] [Indexed: 11/23/2022] Open
Abstract
Autologous Hematopoietic Stem Cell Transplantation (auto-HSCT) has become a therapeutic option for first-line consolidation in Acute Myeloid Leukemia (AML) patients with favorable and intermediate risk features. A total of 101 AML patients in first complete remission, who were not eligible for allogeneic HSCT, were randomized to receive intensive cytarabine-based chemotherapy or to undergo auto-HSCT. The probability of LFS was significantly better in auto-HSCT recipients compared to chemotherapy arm (43% vs 4.8%, p=0.008). At the end of 915 (30-4470) days of followup, the probability of overall survival was better in auto-HSCT group compared to chemotherapy, without statistical significance (79.2% vs 38.8%, p=0.054). Multivariate analysis revealed a significant predictive impact of cytogenetic risk status on OS (p=0.002, HR: 2.824, 95% CI: 1.445-5.521). Auto-HSCT is considered as an effective consolidation approach in favorable and intermadiate risk AML patients.
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Affiliation(s)
- Zeynep Arzu Yegin
- Department of Hematology, Gazi University School of Medicine, Ankara, Turkey
| | - Asena Dikyar
- Department of Hematology, Gazi University School of Medicine, Ankara, Turkey
| | - Lale Aydın Kaynar
- Department of Hematology, Gazi University School of Medicine, Ankara, Turkey
| | - Ferda Can
- Department of Hematology, Gazi University School of Medicine, Ankara, Turkey
| | - Zübeyde Nur Özkurt
- Department of Hematology, Gazi University School of Medicine, Ankara, Turkey
| | - Münci Yağcı
- Department of Hematology, Gazi University School of Medicine, Ankara, Turkey
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Passweg JR, Labopin M, Christopeit M, Cornelissen J, Pabst T, Socié G, Russel N, Yakoub-Agha I, Blaise D, Gedde-Dahl T, Labussière-Wallet H, Malladi R, Forcade E, Maury S, Polge E, Lanza F, Gorin NC, Mohty M, Nagler A. Postremission Consolidation by Autologous Hematopoietic Cell Transplantation (HCT) for Acute Myeloid Leukemia in First Complete Remission (CR) and Negative Implications for Subsequent Allogeneic HCT in Second CR: A Study by the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT). Biol Blood Marrow Transplant 2019; 26:659-664. [PMID: 31759159 DOI: 10.1016/j.bbmt.2019.11.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/02/2019] [Accepted: 11/15/2019] [Indexed: 11/29/2022]
Abstract
After autologous hematopoietic cell transplantation (HCT) in the first complete remission (CR1), patients with acute myeloid leukemia (AML) may relapse and undergo allogeneic HCT in the second complete remission (CR2). The aim of this study was to analyze the outcome of allogeneic HCT performed in CR2 comparing patients with prior consolidation by autologous HCT versus patients with chemotherapy consolidation. Included were 2619 adults with allogeneic HCT in CR2 from 2000 to 2017 with (n = 417) or without (n = 2202) prior autologous HCT. Patient groups were not entirely comparable; patients with prior autologous HCT were younger, had less often a favorable cytogenetic profile, had more commonly donors other than matched siblings, and more often received reduced-intensity conditioning. In multivariate analysis, nonrelapse mortality risks in patients with prior autologous HCT were 1.34 (1.07 to 1.67; P = .01) after adjustment for age, cytogenetic risk, transplant year, donor, conditioning intensity, sex matching, interval diagnosis-relapse, and relapse-allogeneic HCT as compared with chemotherapy consolidation. Similarly, risks of events in leukemia-free survival and graft-versus-host disease, relapse-free survival were higher with prior autologous HCT, 1.17 (1.01 to 1.35), P = .03 and 1.18 (1.03 to 1.35), P = .02, respectively. Risk of death was also higher, 1.13 (0.97 to 1.32), P = .1, but this was not significant. Postremission consolidation with autologous HCT for AML in CR1 increases toxicity of subsequent allogeneic HCT in CR2.
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Affiliation(s)
- J R Passweg
- Division of Hematology, University Hospital Basel, Basel, Switzerland.
| | - M Labopin
- Department of Hematology and Cell Therapy, Institut National de la Santé et de la Recherche Médicale (INSERM) UMRs 938, Hopital Saint Antoine Assistance Publique-Hopitaux de Paris, Paris Sorbonne University, Paris, France
| | - M Christopeit
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Cornelissen
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands
| | - T Pabst
- Department of Medical Oncology, University Hospital, Bern, Switzerland
| | - G Socié
- Department of Hematology-BMT, Hopital St. Louis, Paris France
| | - N Russel
- Department of Haematology, Nottingham City Hospital, Nottingham University, Nottingham, UK
| | - I Yakoub-Agha
- CHU de Lille, LIRIC, INSERM U995, université de Lille, Lille, France
| | - D Blaise
- Programme de Transplantation & Therapie Cellulaire Centre de Recherche en Cancérologie de Marseille Institut Paoli Calmettes, Marseille, France
| | - T Gedde-Dahl
- Department of Hematology, Oslo University Hospital, Rikshospitalet, and Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - R Malladi
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - E Forcade
- CHU Bordeaux, Hôpital Haut-Leveque, Pessac, France
| | - S Maury
- Service d'Hématologie, Hôpital Henri Mondor, Creteil, France
| | - E Polge
- Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT), Paris, France
| | - F Lanza
- Romagna Transplant Network, Ravenna, Italy
| | - N C Gorin
- Department of Hematology and Cell Therapy, Institut National de la Santé et de la Recherche Médicale (INSERM) UMRs 938, Hopital Saint Antoine Assistance Publique-Hopitaux de Paris, Paris Sorbonne University, Paris, France
| | - M Mohty
- Department of Hematology and Cell Therapy, Institut National de la Santé et de la Recherche Médicale (INSERM) UMRs 938, Hopital Saint Antoine Assistance Publique-Hopitaux de Paris, Paris Sorbonne University, Paris, France
| | - A Nagler
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Ramat Gan, Israel
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Adrianzen Herrera D, Kornblum N, Derman O, Bachier-Rodriguez L, Sica RA, Shastri A, Janakiram M, Verma A, Braunschweig I, Mantzaris I. Outcomes of Autologous Hematopoietic Cell Transplantation Compared With Chemotherapy Consolidation Alone for Non-High-Risk Acute Myeloid Leukemia in First Complete Remission in a Minority-Rich Inner-City Cohort With Limited Access to Allografts. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:516-521. [PMID: 31227357 DOI: 10.1016/j.clml.2019.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/01/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION In the United States, autologous hematopoietic cell transplantation (autoHCT) has fallen out of favor over chemotherapy consolidation for non-high-risk acute myeloid leukemia (AML) when allogeneic hematopoietic cell transplantation (alloHCT) is unfeasible, which is common in racial minorities because of donor registry under-representation and socioeconomic challenges. We compared autoHCT consolidation outcomes with chemotherapy alone in a minority-rich cohort in the Bronx. PATIENTS AND METHODS We identified adults with favorable or intermediate cytogenetic risk AML in first complete remission after induction at Montefiore Medical Center from 1999 to 2015, and analyzed 81 patients who received consolidation with ≥2 cycles of chemotherapy, of whom 28 received autoHCT. RESULTS The cohort predominantly consisted of ethnic/racial minorities (69%). Age, sex, race, presenting white cell count, and cytogenetic risk were similar between groups. The autoHCT group had longer relapse-free (RFS; 43 vs. 11 months; P = .003) and overall (OS) survival (not reached vs. 36 months; P = .043). Adjusted multivariable analysis showed significant benefit of autoHCT over chemotherapy alone for RFS (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.37-0.75; P < .001) and OS (HR, 0.61; 95% CI, 0.40-0.95; P = .027). CONCLUSION In this inner-city non-high-risk AML cohort, autoHCT provided OS and RFS benefit compared with chemotherapy alone. AutoHCT might constitute a valuable option for ethnic/racial minorities affected by significant barriers to alloHCT, whereas integration of measurable residual disease can help select patients more likely to benefit.
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Affiliation(s)
- Diego Adrianzen Herrera
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Noah Kornblum
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Olga Derman
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | | | - R Alejandro Sica
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Aditi Shastri
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Murali Janakiram
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Amit Verma
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Ira Braunschweig
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Ioannis Mantzaris
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
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Limvorapitak W, Barnett MJ, Hogge DE, Forrest DL, Nevill TJ, Narayanan S, Power MM, Nantel SH, Broady R, Song KW, Toze CL, Mourad YA, Sutherland HJ, Gerrie AS, White J, Sanford DS. Outcomes of Intermediate Risk Karyotype Acute Myeloid Leukemia in First Remission Undergoing Autologous Stem Cell Transplantation Compared With Allogeneic Stem Cell Transplantation and Chemotherapy Consolidation: A Retrospective, Propensity-score Adjusted Analysis. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:e481-e491. [PMID: 30100330 DOI: 10.1016/j.clml.2018.07.290] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/07/2018] [Accepted: 07/11/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Optimal post-remission therapy (PRT) for intermediate risk acute myeloid leukemia remains an area of ongoing research. We aimed to retrospectively compare outcomes following autologous stem cell transplantation (autoSCT) with allogeneic SCT (alloSCT) and consolidation chemotherapy (CMT) in patients with intermediate-risk karyotype AML in first complete remission. PATIENTS AND METHODS We compared overall survival (OS) and leukemia-free survival (LFS) using propensity score (PS)-adjusted analysis of patients receiving PRT with autoSCT, matched sibling (MSD) alloSCT, unrelated/mismatch (UD/MM) alloSCT, and CMT. We included patients diagnosed between 1984 and 2003 (period of autoSCT at our center) in CR1 following induction CMT and received at least 2 consolidative cycles. RESULTS We identified 190 patients (62 MSD-alloSCT, 18 UD/MM-alloSCT, 30 autoSCT, and 80 CMT). Baseline characteristics were used for PS calculation and were well-balanced after weight adjustment. The median follow-up for patients surviving beyond 1 year was 8.7 years. We excluded 55 patients based on PS calculation. Adjusted multivariate hazard ratio (HR), 95% confidence interval (CI) and P-value for OS, considering CMT as reference, were: MSD-alloSCT (HR, 0.4; 95% CI, 0.2-0.8; P = .009), UD/MM-alloSCT (HR, 1.5; 95% CI, 0.6-3.9; P = .363), and autoSCT (HR, 1.2; 95% CI, 0.5-3.1; P = .666), respectively. Adjusted multivariate HR, 95% CI and P-value for LFS were MSD-alloSCT (HR, 0.3; 95% CI, 0.2-0.6; P < .001), UD/MM-alloSCT (HR, 1.1; 95% CI, 0.4-2.7; P = .854), and autoSCT (HR, 0.8; 95% CI, 0.3-2.2; P = .697), respectively. CONCLUSION Patients with intermediate risk-karyotype acute myeloid leukemia who underwent MSD-alloSCT in first complete remission had the best outcomes. There were no survival differences between autoSCT, UD/MM-alloSCT, and CMT. Further study incorporating molecular changes and minimal residual disease status is warranted to select appropriate patients for autoSCT.
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Affiliation(s)
- Wasithep Limvorapitak
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Michael J Barnett
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Donna E Hogge
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Donna L Forrest
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Thomas J Nevill
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sujaatha Narayanan
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Maryse M Power
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Stephen H Nantel
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Raewyn Broady
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kevin W Song
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Cynthia L Toze
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Yasser Abou Mourad
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Heather J Sutherland
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alina S Gerrie
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer White
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David S Sanford
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Chen J, Yang L, Fan Y, Xu Y, Han Y, Tang X, Qiu H, Fu C, Miao M, Chen F, Wu D. Comparison of Autologous Stem Cell Transplantation versus Haploidentical Donor Stem Cell Transplantation for Favorable- and Intermediate-Risk Acute Myeloid Leukemia Patients in First Complete Remission. Biol Blood Marrow Transplant 2018; 24:779-788. [DOI: 10.1016/j.bbmt.2017.12.796] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/18/2017] [Indexed: 01/03/2023]
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Yoon JH, Kim HJ, Park SS, Jeon YW, Lee SE, Cho BS, Eom KS, Kim YJ, Lee S, Min CK, Cho SG, Kim DW, Lee JW, Min WS. Clinical Outcome of Autologous Hematopoietic Cell Transplantation in Adult Patients with Acute Myeloid Leukemia: Who May Benefit from Autologous Hematopoietic Cell Transplantation? Biol Blood Marrow Transplant 2017; 23:588-597. [DOI: 10.1016/j.bbmt.2017.01.070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/10/2017] [Indexed: 11/12/2022]
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Kannan GS, Aquino-Lopez A, Lee DA. Natural killer cells in malignant hematology: A primer for the non-immunologist. Blood Rev 2016; 31:1-10. [PMID: 27665023 DOI: 10.1016/j.blre.2016.08.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 08/03/2016] [Accepted: 08/29/2016] [Indexed: 12/19/2022]
Abstract
Natural killer cells were first described over 40years ago, but the last 15years has shown tremendous progress in our understanding of their biology and our ability to manipulate them for clinical therapeutic effect. Despite the increased understanding by clinicians and scientists investigating these cells, their biology remains a confusing subject for many because of the wide array of receptors, complex interactions, multiple models of predicting function, and contradictory data in the literature. While they are microscopically indistinguishable from T cells and share many of the same effector functions, their mechanisms of target recognition are completely distinct from yet complimentary to T cells. In this review we provide a basic understanding of NK cell biology and HLA recognition as compared and contrasted to T cells using a metaphor of border patrol and passports. We conclude with a summary of the evidence for NK cell effects in hematologic malignancies and describe new advances in NK cell immunotherapy aimed at improving these effects.
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Affiliation(s)
- Geoffrey S Kannan
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, 450 Brooklyn Ave, Boston, MA 02215, USA.
| | - Arianexys Aquino-Lopez
- Clinical and Translational Sciences Program, University of Texas Graduate School of Biomedical Sciences, 6767 Bertner Avenue, Houston, TX 77030, USA; Division of Pediatrics, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 853, Houston, TX 77030, USA.
| | - Dean A Lee
- Division of Hematology, Oncology, and BMT, Nationwide Children's Hospital, 700 Children's Drive, WA4023, Columbus, OH 43205, USA.
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Mulé MP, Mannis GN, Wood BL, Radich JP, Hwang J, Ramos NR, Andreadis C, Damon L, Logan AC, Martin TG, Hourigan CS. Multigene Measurable Residual Disease Assessment Improves Acute Myeloid Leukemia Relapse Risk Stratification in Autologous Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2016; 22:1974-1982. [PMID: 27544285 DOI: 10.1016/j.bbmt.2016.08.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 08/11/2016] [Indexed: 11/25/2022]
Abstract
We report here the largest study to date of adult patients with acute myeloid leukemia (AML) tested for measurable residual disease (MRD) at the time of autologous hematopoietic cell transplantation (auto-HCT). Seventy-two adult patients who underwent transplantation between 2004 and 2013 at a single academic medical center (University of California San Francisco) were eligible for this retrospective study based on availability of cryopreserved granulocyte colony-stimulating factor (GCSF)-mobilized autologous peripheral blood progenitor cell (PBPC) leukapheresis specimens ("autografts"). Autograft MRD was assessed by molecular methods (real-time quantitative PCR [RQ-PCR] for Wilms tumor 1 (WT1) alone or a multigene panel) and by multiparameter flow cytometry (MPFC). WT1 RQ-PCR testing of the autograft had low sensitivity for relapse prediction (14%) and a negative predictive value of 51%. MPFC failed to identify MRD in any of 34 autografts tested. Combinations of molecular MRD assays, however, improved prediction of post-auto-HCT relapse. In multivariate analysis of clinical variables, including age, gender, race, cytogenetic risk category, and CD34+ cell dose, only autograft multigene MRD as assessed by RQ-PCR was statistically significantly associated with relapse. One year after transplantation, only 28% patients with detectable autograft MRD were relapse free, compared with 67% in the MRD-negative cohort. Multigene MRD, while an improvement on other methods tested, was however suboptimal for relapse prediction in unselected patients, with specificity of 83% and sensitivity of 46%. In patients with known chromosomal abnormalities or mutations, however, better predictive value was observed with no relapses observed in MRD-negative patients in the first year after auto-HCT compared with 83% incidence of relapse in the MRD-positive patients (hazard ratio, 12.45; P = .0016). In summary, increased personalization of MRD monitoring by use of a multigene panel improved the ability to risk stratify patients for post-auto-HCT relapse. WT1 RQ-PCR and flow cytometric assessment for AML MRD in autograft samples had limited value for predicting relapse after auto-HCT. We demonstrate that cryopreserved autograft material presents unique challenges for AML MRD testing because of the masking effects of previous GCSF exposure on gene expression and flow cytometry signatures. In the absence of information regarding diagnostic characteristics, sources other than GCSF-stimulated PBSC leukapheresis specimens should be considered as alternatives for MRD testing in AML patients undergoing auto-HCT.
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Affiliation(s)
- Matthew P Mulé
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Gabriel N Mannis
- Department of Medicine, Division of Hematology and Blood and Marrow Transplantation, University of California, San Francisco, California
| | - Brent L Wood
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Jimmy Hwang
- Department of Medicine, Division of Hematology and Blood and Marrow Transplantation, University of California, San Francisco, California
| | - Nestor R Ramos
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Charalambos Andreadis
- Department of Medicine, Division of Hematology and Blood and Marrow Transplantation, University of California, San Francisco, California
| | - Lloyd Damon
- Department of Medicine, Division of Hematology and Blood and Marrow Transplantation, University of California, San Francisco, California
| | - Aaron C Logan
- Department of Medicine, Division of Hematology and Blood and Marrow Transplantation, University of California, San Francisco, California
| | - Thomas G Martin
- Department of Medicine, Division of Hematology and Blood and Marrow Transplantation, University of California, San Francisco, California
| | - Christopher S Hourigan
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland.
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