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Chen J, Gale RP, Hu Y, Yan W, Wang T, Zhang W. Measurable residual disease (MRD)-testing in haematological and solid cancers. Leukemia 2024; 38:1202-1212. [PMID: 38637690 PMCID: PMC11147778 DOI: 10.1038/s41375-024-02252-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Junren Chen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China.
- Tianjin Institutes of Health Science, Tianjin, China.
| | - Robert Peter Gale
- Centre for Haematology, Department of Immunology and Inflammation, Imperial College of Science, Technology and Medicine, London, UK
| | - Yu Hu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Wen Yan
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Tiantian Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Wei Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
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2
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Ahmed S, Elsherif M, Yassin D, Elsharkawy N, Mohamed AS, Yasser N, Elnashar A, Hafez H, Kolb EA, Elhaddad A. Integration of measurable residual disease by WT1 gene expression and flow cytometry identifies pediatric patients with high risk of relapse in acute myeloid leukemia. Front Oncol 2024; 14:1340909. [PMID: 38720804 PMCID: PMC11077298 DOI: 10.3389/fonc.2024.1340909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/26/2024] [Indexed: 05/12/2024] Open
Abstract
Background Molecular testing plays a pivotal role in monitoring measurable residual disease (MRD) in acute myeloid leukemia (AML), aiding in the refinement of risk stratification and treatment guidance. Wilms tumor gene 1 (WT1) is frequently upregulated in pediatric AML and serves as a potential molecular marker for MRD. This study aimed to evaluate WT1 predictive value as an MRD marker and its impact on disease prognosis. Methods Quantification of WT1 expression levels was analyzed using the standardized European Leukemia Network real-time quantitative polymerase chain reaction assay (qRT-PCR) among a cohort of 146 pediatric AML patients. Post-induction I and intensification I, MRD response by WT1 was assessed. Patients achieving a ≥2 log reduction in WT1MRD were categorized as good responders, while those failing to reach this threshold were classified as poor responders. Results At diagnosis, WT1 overexpression was observed in 112 out of 146 (76.7%) patients. Significantly high levels were found in patients with M4- FAB subtype (p=0.018) and core binding fusion transcript (CBF) (RUNX1::RUNX1T1, p=0.018, CBFB::MYH11, p=0.016). Following induction treatment, good responders exhibited a reduced risk of relapse (2-year cumulative incidence of relapse [CIR] 7.9% vs 33.2%, p=0.008). Conversely, poor responders' post-intensification I showed significantly lower overall survival (OS) (51% vs 93.2%, p<0.001), event-free survival (EFS) (33.3% vs 82.6%, p<0.001), and higher CIR (66.6% vs 10.6%, p<0.001) at 24 months compared to good responders. Even after adjusting for potential confounders, it remained an independent adverse prognostic factor for OS (p=0.04) and EFS (p=0.008). High concordance rates between WT1-based MRD response and molecular MRD were observed in CBF patients. Furthermore, failure to achieve either a 3-log reduction by RT-PCR or a 2-log reduction by WT1 indicated a high risk of relapse. Combining MFC-based and WT1-based MRD results among the intermediate-risk group identified patients with unfavorable prognosis (positive predictive value [PPV] 100%, negative predictive value [NPV] 85%, and accuracy 87.5%). Conclusion WT1MRD response post-intensification I serves as an independent prognostic factor for survival in pediatric AML. Integration of WT1 and MFC-based MRD results enhances the reliability of MRD-based prognostic stratification, particularly in patients lacking specific leukemic markers, thereby influencing treatment strategies.
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Affiliation(s)
- Sonia Ahmed
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
- Department of Pediatric Oncology, Children’s Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Mariam Elsherif
- Department of Pediatric Oncology, Children’s Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Dina Yassin
- Department of Clinical Pathology, Children’s Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
- Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Nahla Elsharkawy
- Department of Clinical Pathology, Children’s Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
- Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ayman S. Mohamed
- Department of Clinical Pathology, Children’s Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Nouran Yasser
- Department of Research and Biostatistics, Children’s Cancer Hospital (CCHE-57357), Cairo, Egypt
| | - Amr Elnashar
- Department of Research and Biostatistics, Children’s Cancer Hospital (CCHE-57357), Cairo, Egypt
| | - Hanafy Hafez
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
- Department of Pediatric Oncology, Children’s Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Edward A. Kolb
- Department of Pediatric Hematology and Oncology, Nemours Center for Cancer and Blood Disorders, Wilmington, DE, United States
- Leukemia and Lymphoma Society, Rye Brook, NY, United States
| | - Alaa Elhaddad
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
- Department of Pediatric Oncology, Children’s Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
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3
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Wu J, Yan H, Xiang C. Wilms' tumor gene 1 in hematological malignancies: friend or foe? Hematology 2023; 28:2254557. [PMID: 37668240 DOI: 10.1080/16078454.2023.2254557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023] Open
Abstract
Wilms' tumor gene 1 (WT1) is a transcription and post-translational factor that has a crucial role in the biological and pathological processes of several human malignancies. For hematological malignancies, WT1 overexpression or mutation has been found in leukemia and myelodysplastic syndrome. About 70-90% of acute myeloid leukemia patients showed WT1 overexpression, and 6-15% of patients carried WT1 mutations. WT1 has been widely regarded as a marker for monitoring minimal residual disease in acute myeloid leukemia. Many researchers were interested in developing WT1 targeting therapy. In this review, we summarized biological and pathological functions, correlation with other genes and clinical features, prognosis value and targeting therapy of WT1 in hematological features.
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Affiliation(s)
- Jie Wu
- Department of Emergency Medicine, The Fifth People's Hospital of Huai'an and Huai'an Hospital Affiliated to Yangzhou University, Huai'an, People's Republic of China
| | - Hui Yan
- Department of Clinical Medicine, Medical College, Yangzhou University, Yangzhou, People's Republic of China
| | - Chunli Xiang
- Department of General Medicine, The Affiliated Huai'an Hospital of Xuzhou Medical University and Huai'an Second People's Hospital, Huai'an, People's Republic of China
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4
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The Role of Wilms' Tumor Gene (WT1) Expression as a Marker of Minimal Residual Disease in Acute Myeloid Leukemia. J Clin Med 2022; 11:jcm11123306. [PMID: 35743376 PMCID: PMC9225390 DOI: 10.3390/jcm11123306] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 12/17/2022] Open
Abstract
The Minimal Residual Disease(MRD) monitoring in acute myeloid leukemia (AML) is crucial to guide treatment after morphologic complete remission, to define the need for consolidation with allogeneic stem cell transplantation (Allo-SCT), and to detect impending relapse allowing early intervention. However, more than 50% of patients with AML lack a specific or measurable molecular marker to monitor MRD. We reviewed the key studies on WT1 overexpression as a marker of MRD in AML patients undergoing an intensive chemotherapy program, including Allo-SCT. In addition, we provided some practical considerations on how to properly use WT1 expression as an MRD marker, considering its strengths and weaknesses. In order to achieve the best sensitivity and specificity, it is recommended to refer to the standardized method of European LeukemiaNet and its defined threshold (250 WT1 copies/104 Abelson (ABL) on Bone Marrow-BM and 50 WT1 copies/104 ABL on Peripheral Blood-PB), which has been validated in a large and multicenter cohort of patients and normal controls.
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5
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Guolo F, Di Grazia C, Minetto P, Raiola AM, Clavio M, Miglino M, Tedone E, Contini P, Mangerini R, Kunkl A, Colombo N, Pugliese G, Carminati E, Marcolin R, Passannante M, Bagnasco S, Galaverna F, Lamparelli T, Ballerini F, Cagnetta A, Cea M, Gobbi M, Bacigalupo A, Lemoli RM, Angelucci E. Pre-transplant minimal residual disease assessment and transplant-related factors predict the outcome of acute myeloid leukemia patients undergoing allogeneic stem cell transplantation. Eur J Haematol 2021; 107:573-582. [PMID: 34297437 DOI: 10.1111/ejh.13694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 12/27/2022]
Abstract
We studied pretransplant minimal residual disease (MRD) in 224 patients (median age 44 years; range 17-65) with acute myeloid leukemia (AML) undergoing allogeneic stem cell transplant (HSCT) in complete remission. MRD was evaluated on marrow samples using multicolor flow cytometry and assessment of WT1 gene expression. Both methods showed a strong prognostic value and their combination allowed the identification of three groups of patients with different risk of relapse. In multivariate analysis, combined MRD was the only predictor of cumulative incidence of relapse, regardless of donor type, conditioning regimen, first or second CR at HSCT, HSCT year, and ELN risk group. Multivariate regression model showed that only negative combined MRD status (P < .001) and myeloablative conditioning (P = .004) were independently associated with better OS. Among MRD-positive patients, a reduced incidence of relapse was observed in patients receiving haplo transplant (P < .05) and in patients who showed grade II-IV aGVHD (P < .03). In patients with negative combined MRD, the intensity of conditioning regimen did not affect the overall favorable outcome. We suggest that pretransplant MRD evaluation combined with transplant-related factors can identify AML patients at higher risk for relapse and might help in defining the overall transplant strategy.
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Affiliation(s)
- Fabio Guolo
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | | | - Paola Minetto
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | | | - Marino Clavio
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Maurizio Miglino
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | | | - Paola Contini
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | | | - Girolamo Pugliese
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Enrico Carminati
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Riccardo Marcolin
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Monica Passannante
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Samuele Bagnasco
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Federica Galaverna
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | | | - Filippo Ballerini
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Antonia Cagnetta
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Michele Cea
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Marco Gobbi
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | | | - Roberto Massimo Lemoli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
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Craddock C, Jackson A, Loke J, Siddique S, Hodgkinson A, Mason J, Andrew G, Nagra S, Malladi R, Peniket A, Gilleece M, Salim R, Tholouli E, Potter V, Crawley C, Wheatley K, Protheroe R, Vyas P, Hunter A, Parker A, Wilson K, Pavlu J, Byrne J, Dillon R, Khan N, McCarthy N, Freeman SD. Augmented Reduced-Intensity Regimen Does Not Improve Postallogeneic Transplant Outcomes in Acute Myeloid Leukemia. J Clin Oncol 2021; 39:768-778. [PMID: 33373276 PMCID: PMC8078252 DOI: 10.1200/jco.20.02308] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/10/2020] [Accepted: 12/04/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Reduced-intensity conditioning (RIC) regimens have extended the curative potential of allogeneic stem-cell transplantation to older adults with high-risk acute myeloid leukemia (AML) and myelodysplasia (MDS) but are associated with a high risk of disease relapse. Strategies to reduce recurrence are urgently required. Registry data have demonstrated improved outcomes using a sequential transplant regimen, fludarabine/amsacrine/cytarabine-busulphan (FLAMSA-Bu), but the impact of this intensified conditioning regimen has not been studied in randomized trials. PATIENTS AND METHODS Two hundred forty-four patients (median age, 59 years) with high-risk AML (n = 164) or MDS (n = 80) were randomly assigned 1:1 to a fludarabine-based RIC regimen or FLAMSA-Bu. Pretransplant measurable residual disease (MRD) was monitored by flow cytometry (MFC-MRD) and correlated with outcome. RESULTS There was no difference in 2-year overall survival (hazard ratio 1.05 [85% CI, 0.80 to 1.38] P = .81) or cumulative incidence of relapse (CIR) (hazard ratio 0.94 [95%CI, 0.60 to 1.46] P = .81) between the control and FLAMSA-Bu arms. Detectable pretransplant MFC-MRD was associated with an increased CIR (2-year CIR 41.0% v 20.0%, P = .01) in the overall trial cohort with a comparable prognostic impact when measured by an unsupervised analysis approach. There was no evidence of interaction between MRD status and conditioning regimen intensity for relapse or survival. Acquisition of full donor T-cell chimerism at 3 months abrogated the adverse impact of pretransplant MRD on CIR and overall survival. CONCLUSION The intensified RIC conditioning regimen, FLAMSA-Bu, did not improve outcomes in adults transplanted for high-risk AML or MDS regardless of pretransplant MRD status. Our data instead support the exploration of interventions with the ability to accelerate acquisition of full donor T-cell chimerism as a tractable strategy to improve outcomes in patients allografted for AML.
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Affiliation(s)
- Charles Craddock
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | - Aimee Jackson
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | - Justin Loke
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Shamyla Siddique
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | - Andrea Hodgkinson
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | - John Mason
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | - Georgia Andrew
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - Sandeep Nagra
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Ram Malladi
- Addenbrookes Hospital, Cambridge, United Kingdom
| | | | | | | | | | | | | | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | | | | | - Ann Hunter
- Leicester Royal Infirmary, United Kingdom
| | - Anne Parker
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | | | - Jiri Pavlu
- Imperial College Hospital, London, Unite Kingdom
| | - Jenny Byrne
- Centre for Clinical Haematology, Nottingham, United Kingdom
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Naeem Khan
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - Nicholas McCarthy
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - Sylvie D. Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
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7
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Hematogones in patients with acute myeloid leukaemia: Prognostic value and correlation with minimal residual disease. Leuk Res Rep 2021; 15:100234. [PMID: 33489749 PMCID: PMC7810761 DOI: 10.1016/j.lrr.2021.100234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/12/2020] [Accepted: 01/05/2021] [Indexed: 11/21/2022] Open
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Guolo F, Fianchi L, Minetto P, Clavio M, Gottardi M, Galimberti S, Rizzuto G, Rondoni M, Bertani G, Dargenio M, Bilio A, Scappini B, Zappasodi P, Scattolin AM, Grimaldi F, Pietrantuono G, Musto P, Cerrano M, D'Ardia S, Audisio E, Cignetti A, Pasciolla C, Pavesi F, Candoni A, Gurreri C, Morselli M, Alati C, Fracchiolla N, Rossi G, Caizzi M, Carnevale-Schianca F, Tafuri A, Rossi G, Ferrara F, Pagano L, Lemoli RM. CPX-351 treatment in secondary acute myeloblastic leukemia is effective and improves the feasibility of allogeneic stem cell transplantation: results of the Italian compassionate use program. Blood Cancer J 2020; 10:96. [PMID: 33024084 PMCID: PMC7538937 DOI: 10.1038/s41408-020-00361-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/19/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023] Open
Abstract
Secondary acute myeloid leukemia (sAML) poorly responds to conventional treatments and allogeneic stem cell transplantation (HSCT). We evaluated toxicity and efficacy of CPX-351 in 71 elderly patients (median age 66 years) with sAML enrolled in the Italian Named (Compassionate) Use Program. Sixty days treatment-related mortality was 7% (5/71). The response rate at the end of treatment was: CR/CRi in 50/71 patients (70.4%), PR in 6/71 (8.5%), and NR in 10/71 (19.7%). After a median follow-up of 11 months relapse was observed in 10/50 patients (20%) and 12 months cumulative incidence of relapse (CIR) was 23.6%. Median duration of response was not reached. In competing risk analysis, CIR was reduced when HSCT was performed in first CR (12 months CIR of 5% and 37.4%, respectively, for patients receiving (=20) or not (=30) HSCT, p = 0.012). Twelve-months OS was 68.6% (median not reached). In landmark analysis, HSCT in CR1 was the only significant predictor of longer survival (12 months OS of 100 and 70.5%, for patients undergoing or not HSCT in CR1, respectively, p = 0.011). In conclusion, we extend to a real-life setting, the notion that CPX is an effective regimen for high risk AML patients and may improve the results of HSCT.
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Affiliation(s)
- Fabio Guolo
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy. .,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy.
| | - Luana Fianchi
- Istituto di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Paola Minetto
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Marino Clavio
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | | | - Sara Galimberti
- UO Ematologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
| | - Giuliana Rizzuto
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michela Rondoni
- U.O.C. di Ematologia, Azienda Unità Sanitaria Locale della Romagna, Ravenna, Italy
| | - Giambattista Bertani
- S.C. Ematologia, ASST Grande Ospedale Metropolitano, Niguarda Ca' Granda Milano, Milan, Italy
| | | | | | - Barbara Scappini
- Dipartimento di Oncologia-SODc Ematologia, Azienda Ospedaliero - Universitaria Careggi, Florence, Italy
| | - Patrizia Zappasodi
- Clinica Ematologica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Francesco Grimaldi
- Dipartimento di Medicina Clinica e Chirurgia, AOU Federico II di Napoli, Naples, Italy
| | | | - Pellegrino Musto
- IRCCS Centro Oncologico della Basilicata, Rionero in Vulture, Potenza, Italy.,Unit of Hematology and Stem Cell Transplantation, AOU Policlinico Consorziale, "Aldo Moro" University, Bari, Italy
| | - Marco Cerrano
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Turin, Italy
| | - Stefano D'Ardia
- Institute for Cancer Research and Treatment, University of Turin-School of Medicine, Turin, Italy
| | - Ernesta Audisio
- S.C. Ematologia2, Dipartimento di Ematologia e Oncologia, AO Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alessandro Cignetti
- Divisione Universitaria di Ematologia e Terapie Cellulari, A.O. Ordine Mauriziano, Turin, Italy
| | | | - Francesca Pavesi
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Anna Candoni
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Carmela Gurreri
- U.O. Ematologia ed Immunologia Clinica, Azienda Ospedaliera di Padova, Padova, Italy
| | - Monica Morselli
- Department of Medical and Surgical Sciences, Section of Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | | | - Nicola Fracchiolla
- Oncoematologia, IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Milan, Italy
| | - Giovanni Rossi
- U.O. Ematologia, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Foggia, Italy
| | - Manuela Caizzi
- S.C. Ematologia Azienda Sanitaria Universitaria Integrata di Trieste, Ospedale Maggiore, Trieste, Italy
| | - Fabrizio Carnevale-Schianca
- Medical Oncology, Hematopoietic Stem Cells Unit, Turin Metropolitan Transplant Center, Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | - Agostino Tafuri
- Department of Clinical and Molecular Medicine & Hematology, Sant'Andrea - University Hospital - Sapienza - University of Rome, Rome, Italy
| | - Giuseppe Rossi
- SC Ematologia e Dipartimento di Oncologia Clinica, A.O. Spedali Civili, Brescia, Italy
| | | | - Livio Pagano
- Istituto di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Roberto Massimo Lemoli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
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9
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The Proportional Relationship Between Pretransplant WT1 mRNA Levels and Risk of Mortality After Allogeneic Hematopoietic Cell Transplantation in Acute Myeloid Leukemia Not in Remission. Transplantation 2020; 103:2201-2210. [PMID: 30801534 DOI: 10.1097/tp.0000000000002662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The relationship between the expression levels of Wilms' tumor-1 gene (WT1) mRNA in peripheral blood before allogeneic hematopoietic cell transplantation (allo-HCT) and risk of mortality in acute myeloid leukemia (AML) patients in noncomplete remission (non-CR) remains quite elusive. METHODS We retrospectively assessed the impact of the pretransplant WT1 mRNA level on survival after allo-HCT in non-CR AML patients. RESULTS A total of 125 AML patients, including 46 non-CR patients (36.8%), were analyzed. On multivariate analysis of non-CR AML patients, WT1 mRNA ≥5000 copies/μg RNA was significantly related to increased risk of mortality (hazard ratio, 2.7; 95% confidence interval, 1.3-5.5; P = 0.008). Furthermore, in the entire cohort, log10-transformed WT1 mRNA before allo-HCT was found to be significantly associated with the increased risk of mortality irrespective of whether the disease status was CR or non-CR, using Akaike's information criterion. As the pretransplant WT1 mRNA level elevated, the hazard ratio of mortality monotonically increased in a nonlinear manner regardless of remission status, suggesting that WT1 mRNA level in peripheral blood might reflect tumor burden. CONCLUSIONS This study demonstrated that the pretransplant WT1 mRNA level was a powerful prognostic factor in allo-HCT even for non-CR AML patients, and there may be a WT1 mRNA threshold in non-CR patients for benefiting from allo-HCT.
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10
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Guolo F, Minetto P, Clavio M, Marcolin R, Miglino M, Passannante M, Caviglia F, Ballerini F, Tedone E, Kunkl A, Mangerini R, Contini P, Colombo N, Cagnetta A, Cea M, Carminati E, Pugliese G, Gobbi M, Lemoli RM. Prognostic relevance of a blastic plasmacytoid dendritic cell neoplasm-like immunophenotype in cytogenetically normal acute myeloid leukemia patients. Leuk Lymphoma 2020; 61:1695-1701. [PMID: 32186422 DOI: 10.1080/10428194.2020.1737685] [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
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a poor prognosis myeloid malignancy characterized by an atypical phenotype (CD123+, CD56+, and CD4+). We reported that BPDCN-like phenotype (CD123+ and either CD56+ or CD4+ or both) confers poor prognosis to acute myeloblastic leukemia (AML) patients with mutated NPM1. Here, we evaluated the incidence and the prognostic relevance of BPDCN-like phenotype in cytogenetically normal AML (CN-AML) patients. From 2006 to 2016, 83 young (age <60 yrs), consecutive, CN-AML patients underwent intensive treatment. Fifteen patients (18%) showed a BPDCN-like phenotype with no difference between NPM1-mutated (mut) and NPM1-wt patients. It did not significantly affect survival neither in the whole cohort, nor in NPM1-wt patients. However, as reported, it conferred a dismal prognosis in NPM1-mut AML (p < 0.001), irrespectively of the mutational status for FLT3-ITD. In conclusion we show that BPDCN-like phenotype displays a negative prognostic relevance only in NPM1-mutated AML.
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Affiliation(s)
- Fabio Guolo
- Department of Oncology and Hematology, Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Paola Minetto
- Department of Oncology and Hematology, Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Marino Clavio
- Department of Oncology and Hematology, Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Riccardo Marcolin
- Department of Oncology and Hematology, Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Maurizio Miglino
- Department of Oncology and Hematology, Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Monica Passannante
- Department of Oncology and Hematology, Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Fabrizio Caviglia
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Filippo Ballerini
- Department of Oncology and Hematology, Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Elisabetta Tedone
- Department of Oncology and Hematology, Ospedale Policlinico San Martino, Genoa, Italy.,Clinical Flow Cytometry Unit, Department of Pathology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Annalisa Kunkl
- Department of Oncology and Hematology, Ospedale Policlinico San Martino, Genoa, Italy.,Clinical Flow Cytometry Unit, Department of Pathology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Rosa Mangerini
- Department of Oncology and Hematology, Ospedale Policlinico San Martino, Genoa, Italy.,Clinical Flow Cytometry Unit, Department of Pathology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Paola Contini
- Clinical Flow Cytometry Unit, Department of Pathology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Nicoletta Colombo
- Department of Oncology and Hematology, Ospedale Policlinico San Martino, Genoa, Italy.,Clinical Flow Cytometry Unit, Department of Pathology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonia Cagnetta
- Department of Oncology and Hematology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Michele Cea
- Department of Oncology and Hematology, Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Enrico Carminati
- Department of Oncology and Hematology, Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Girolamo Pugliese
- Department of Oncology and Hematology, Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Marco Gobbi
- Department of Oncology and Hematology, Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Roberto Massimo Lemoli
- Department of Oncology and Hematology, Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
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11
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Andreani G, Cilloni D. Strategies for minimal residual disease detection: current perspectives. BLOOD AND LYMPHATIC CANCER-TARGETS AND THERAPY 2019; 9:1-8. [PMID: 31807111 PMCID: PMC6855617 DOI: 10.2147/blctt.s172693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 12/13/2018] [Indexed: 11/25/2022]
Abstract
Currently, the post-remission treatment in acute leukemia is based on the genetic profile of leukemic cells at diagnosis (ie, FLT3 ITD positivity) and on the level of measurable residual disease (MRD) after induction and consolidation chemotherapy. Two methods are currently preferred for MRD evaluation in many centers: multiparameter flow cytometry and real-time quantitative PCR. Additional methods such as next-generation sequencing and digital PCR are under investigation, in an attempt to increase the sensitivity and thus allowing the detection of small clones. Many studies suggest that MRD positivity after chemotherapy is associated with negative prognosis, and the reappearance of MRD during follow-up allows impending relapse to be identified and consequently enables early intervention. Finally, MRD positivity before hematopoietic stem cell transplantation is predictive of the outcome. Although the significance of MRD in acute leukemia has been widely explored, the assessment of molecular MRD is not yet a routine practice. In this review, we describe the significance of MRD in different settings and the main markers and methods used for MRD detection.
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Affiliation(s)
- Giacomo Andreani
- Department of Clinical and Biological Sciences, University of Turin, Turin,Italy
| | - Daniela Cilloni
- Department of Clinical and Biological Sciences, University of Turin, Turin,Italy
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12
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Cloos J, Ossenkoppele GJ, Dillon R. Minimal residual disease and stem cell transplantation outcomes. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:617-625. [PMID: 31808862 PMCID: PMC6913494 DOI: 10.1182/hematology.2019000006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Risk classification and tailoring of treatment are essential for improving outcome for patients with acute myeloid leukemia or high-risk myelodysplastic syndrome. Both patient and leukemia-specific characteristics assessed using morphology, cytogenetics, molecular biology, and multicolor flow cytometry are relevant at diagnosis and during induction, consolidation, and maintenance phases of the treatment. In particular, minimal residual disease (MRD) during therapy has potential as a prognostic factor of outcome, determination of response to therapy, and direction of targeted therapy. MRD can be determined by cell surface markers using multicolor flow cytometry, whereas leukemia-specific translocations and mutations are measured using polymerase chain reaction-based techniques and recently using next-generation sequencing. All these methods of MRD detection have their (dis)advantages, and all need to be standardized, prospectively validated, and improved to be used for uniform clinical decision making and a potential surrogate end point for clinical trials testing novel treatment strategies. Important issues to be solved are time point of MRD measurement and threshold for MRD positivity. MRD is used for stem cell transplantation (SCT) selection in the large subgroup of patients with an intermediate risk profile. Patients who are MRD positive will benefit from allo-SCT. However, MRD-negative patients have a better chance of survival after SCT. Therefore, it is debated whether MRD-positive patients should be extensively treated to become MRD negative before SCT. Either way, accurate monitoring of potential residual or upcoming disease is mandatory. Tailoring therapy according to MRD monitoring may be the most successful way to provide appropriate specifically targeted, personalized treatment.
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Affiliation(s)
- Jacqueline Cloos
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, VUMC, Amsterdam, The Netherlands; and
| | - Gert J Ossenkoppele
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, VUMC, Amsterdam, The Netherlands; and
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
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13
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A simple cytofluorimetric score may optimize testing for biallelic CEBPA mutations in patients with acute myeloid leukemia. Leuk Res 2019; 86:106223. [DOI: 10.1016/j.leukres.2019.106223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 11/24/2022]
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14
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Montesinos P, Bergua J, Infante J, Esteve J, Guimaraes JE, Sierra J, Sanz MÁ. Update on management and progress of novel therapeutics for R/R AML: an Iberian expert panel consensus. Ann Hematol 2019; 98:2467-2483. [PMID: 31667544 DOI: 10.1007/s00277-019-03820-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 10/08/2019] [Indexed: 12/19/2022]
Abstract
A significant proportion of adult patients with acute myeloid leukemia (AML) fail to achieve complete remission or will relapse later on after achieving it. Prognosis for relapsed or refractory (R/R) AML patients remains discouraging, with the main curative option still relying on hematopoietic stem cell transplant (HSCT) for those who are eligible. Beyond morphological bone marrow and peripheral blood assessment, evaluation of patient performance status and comorbidities, as well as genetic/molecular characterization, is crucial to make an accurate diagnosis and prognosis, which will be useful to select the most appropriate treatment. Emerging strategies are mainly focusing on the development of immune- and molecular-based approaches. Novel targeted therapies are generally well tolerated, potentially allowing them to be administered alone or in combination with classical chemotherapy agents. Enrolment in clinical trials should be considered first option for R/R AML patients, either as a bridge to HSCT or to benefit from novel therapies that eventually may prolong survival and improve quality of life. An Iberian expert panel has reviewed the recent advances in the management of R/R AML with the aim to develop updated evidence and expert opinion-based recommendations.
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Affiliation(s)
- Pau Montesinos
- Hematology Department, Hospital Universitari I Politècnic La Fe, Av. Fernando Abril Martorell, 106, 46026, Valencia, Spain. .,CIBERONC, Instituto de Salud Carlos III, Madrid, Spain.
| | - Juan Bergua
- Division of Hematology/Oncology, Hospital San Pedro Alcántara, Cáceres, Spain
| | - Joana Infante
- Serviço de Hematologia e Transplantação de Medula Óssea, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisbon, Portugal
| | - Jordi Esteve
- Department of Hematology, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - José Eduardo Guimaraes
- Serviço de Hematologia Clínica, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Jordi Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - Miguel Ángel Sanz
- Hematology Department, Hospital Universitari I Politècnic La Fe, Av. Fernando Abril Martorell, 106, 46026, Valencia, Spain
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15
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WT1 Measurable Residual Disease Assay in Patients With Acute Myeloid Leukemia Who Underwent Allogeneic Hematopoietic Stem Cell Transplantation: Optimal Time Points, Thresholds, and Candidates. Biol Blood Marrow Transplant 2019; 25:1925-1932. [DOI: 10.1016/j.bbmt.2019.05.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 11/18/2022]
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16
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Maurillo L, Bassan R, Cascavilla N, Ciceri F. Quality of Response in Acute Myeloid Leukemia: The Role of Minimal Residual Disease. Cancers (Basel) 2019; 11:cancers11101417. [PMID: 31548502 PMCID: PMC6826465 DOI: 10.3390/cancers11101417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/09/2019] [Accepted: 09/16/2019] [Indexed: 12/22/2022] Open
Abstract
In the acute myeloid leukemia (AML) setting, research has extensively investigated the existence and relevance of molecular biomarkers, in order to better tailor therapy with newly developed agents and hence improve outcomes and/or save the patient from poorly effective therapies. In particular, in patients with AML, residual disease after therapy does reflect the sum of the contributions of all factors associated with diagnosis and post-diagnosis resistance. The evaluation of minimal/measurable residual disease (MRD) can be considered as a key tool to guide patient’s management and a promising endpoint for clinical trials. In this narrative review, we discuss MRD evaluation as biomarker for tailored therapy in AML patients; we briefly report current evidence on the use of MRD in clinical practice, and comment on the potential ability of MRD in the assessment of the efficacy of new molecules.
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Affiliation(s)
- Luca Maurillo
- Hematology Unit, Department of Biomedicine and Prevention, Fondazione Policlinico Tor Vergata, Hospital, 00133 Rome, Italy.
| | - Renato Bassan
- Hematology Unit, dell'Angelo Hospital and Santissimi Giovanni and Paolo Hospital, 30174 Mestre and Venice, Italy.
| | - Nicola Cascavilla
- Hematology Unit, Onco-hematology Department, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo (FG), Italy.
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, IRCCS S. Raffaele Scientific Institution, 20132 Milan, Italy.
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17
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Guolo F, Minetto P, Clavio M, Miglino M, Colombo N, Cagnetta A, Cea M, Marcolin R, Todiere A, Ballerini F, Gobbi M, Lemoli RM. Longitudinal minimal residual disease (MRD) evaluation in acute myeloid leukaemia with
NPM1
mutation: from definition of molecular relapse to MRD‐driven salvage approach. Br J Haematol 2019; 186:e223-e225. [DOI: 10.1111/bjh.16116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Fabio Guolo
- Clinic of Haematology, Department of Internal Medicine (DiMI) University of Genoa Genoa Italy
- IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Paola Minetto
- Clinic of Haematology, Department of Internal Medicine (DiMI) University of Genoa Genoa Italy
- IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Marino Clavio
- Clinic of Haematology, Department of Internal Medicine (DiMI) University of Genoa Genoa Italy
- IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Maurizio Miglino
- Clinic of Haematology, Department of Internal Medicine (DiMI) University of Genoa Genoa Italy
- IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Nicoletta Colombo
- Clinic of Haematology, Department of Internal Medicine (DiMI) University of Genoa Genoa Italy
- IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Antonia Cagnetta
- Clinic of Haematology, Department of Internal Medicine (DiMI) University of Genoa Genoa Italy
- IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Michele Cea
- Clinic of Haematology, Department of Internal Medicine (DiMI) University of Genoa Genoa Italy
- IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Riccardo Marcolin
- Clinic of Haematology, Department of Internal Medicine (DiMI) University of Genoa Genoa Italy
- IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Andrea Todiere
- Clinic of Haematology, Department of Internal Medicine (DiMI) University of Genoa Genoa Italy
- IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Filippo Ballerini
- Clinic of Haematology, Department of Internal Medicine (DiMI) University of Genoa Genoa Italy
- IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Marco Gobbi
- Clinic of Haematology, Department of Internal Medicine (DiMI) University of Genoa Genoa Italy
- IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Roberto Massimo Lemoli
- Clinic of Haematology, Department of Internal Medicine (DiMI) University of Genoa Genoa Italy
- IRCCS Ospedale Policlinico San Martino Genoa Italy
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18
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Biological versus Clinical Risk Factors in Acute Myeloid Leukemia: Is There a Winner? Case Rep Hematol 2019; 2019:3914828. [PMID: 31281685 PMCID: PMC6594262 DOI: 10.1155/2019/3914828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/04/2019] [Indexed: 11/19/2022] Open
Abstract
We present a case of a patient with a three-month history of peripheral blood cytopenia without a confirmed diagnosis of myelodysplastic syndrome, who developed a favourable-risk acute myeloid leukemia (AML), according to the European Leukemia Net (ELN) criteria. The patient achieved a complete remission with incomplete platelet recovery (CRi) after induction. The patient achieved the morphological CR after the first consolidation and completed the first-line treatment with a syngeneic stem cell transplantation (SCT). A disease relapse occurred after one year of CR (blast cell count in the bone marrow 15%), and the patient was offered a haplo-SCT, which he refused due to personal reasons. In this paper, we discuss the interplay between clinical and biological risk factors in non-high-risk AML patients and speculate that some old clinical risk factors (e.g., age of the patient, achievement of CR after induction, and previous history of myelodysplastic syndrome) may still impact on the treatment decision algorithm of some of these patients.
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19
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Prognostic Impact of Blood MN1 Copy Numbers Before Allogeneic Stem Cell Transplantation in Patients With Acute Myeloid Leukemia. Hemasphere 2019; 3:e167. [PMID: 31723806 PMCID: PMC6745933 DOI: 10.1097/hs9.0000000000000167] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/27/2018] [Indexed: 01/02/2023] Open
Abstract
High expression of the leukemia-associated gene meningioma-1 (MN1) is frequently found at diagnosis of acute myeloid leukemia (AML) and associates with adverse outcomes. The presence of measurable residual disease (MRD) in complete remission (CR) indicates high risk of relapse and worse outcome in AML patients. However, the prognostic impact of MN1 expression levels as MRD marker has not been evaluated. Digital droplet polymerase chain reaction (ddPCR) is a novel technique allowing sensitive and specific absolute gene expression quantification. We retrospectively analyzed 124 AML patients who received allogeneic hematopoietic stem cell transplantation (HSCT) in CR or CR with incomplete peripheral recovery. Absolute MN1 copy numbers in peripheral blood were assessed prior to HSCT (median 7; range 0-29 days) using ddPCR. High pre-HSCT MN1/Abelson murine leukemia viral oncogene homolog 1 gene (ABL1) copy numbers associated with a higher cumulative incidence of relapse after HSCT and-in relapsing patients-shorter time to relapse. In multivariable analysis, high pre-HSCT MN1/ABL1 copy numbers remained an independent prognosticator for relapse after HSCT. Patients with the highest pre-HSCT MN1/ABL1 copy numbers also had the highest risk of relapse. MN1 copy number assessment also added prognostic information to nucleophosmin 1 gene (NPM1) mutation- and brain and acute leukemia, cytoplasmic (BAALC) and Wilm's tumor gene 1 (WT1) expression-based MRD evaluation. Our study demonstrates the feasibility of the novel ddPCR technique for MN1/ABL1 copy number assessment as a marker for MRD. Evaluation of MN1/ABL1 copy numbers allows the identification of patients at high risk of relapse, independently of other diagnostic risk factors and MRD markers.
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20
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Mashima K, Oh I, Ikeda T, Toda Y, Ito S, Umino K, Minakata D, Nakano H, Morita K, Yamasaki R, Kawasaki Y, Sugimoto M, Yamamoto C, Ashizawa M, Fujiwara SI, Hatano K, Sato K, Omine K, Muroi K, Kanda Y. Role of Sequential Monitoring of WT1 Gene Expression in Patients With Acute Myeloid Leukemia for the Early Detection of Leukemia Relapse. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:e521-e527. [DOI: 10.1016/j.clml.2018.07.298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/20/2018] [Accepted: 07/27/2018] [Indexed: 01/13/2023]
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21
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Buccisano F, Hourigan CS, Walter RB. The Prognostic Significance of Measurable ("Minimal") Residual Disease in Acute Myeloid Leukemia. Curr Hematol Malig Rep 2018; 12:547-556. [PMID: 29027628 DOI: 10.1007/s11899-017-0420-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review was to evaluate recent literature on detection methodologies for, and prognostic significance of, measurable ("minimal") residual disease (MRD) in acute myeloid leukemia (AML). RECENT FINDINGS There is no "one-fits-all" approach to MRD testing in AML. Most exploited to date are methods relying on immunophenotypic aberrancies (identified via multiparameter flow cytometry) or genetic abnormalities (identified via PCR-based assays). Current methods have important shortcomings, including the lack of assay platform standardization/harmonization across laboratories. In parallel to refinements of existing technologies and data analysis/interpretation, new methodologies (e.g., next-generation sequencing-based assays) are emerging that eventually may complement or replace existing ones. This dynamic evolution of MRD testing has complicated comparisons between individual studies. Nonetheless, an ever-growing body of data demonstrates that a positive MRD test at various time points throughout chemotherapy and hematopoietic cell transplantation identifies patients at particularly high risks of disease recurrence and short survival even after adjustment for other risk factors.
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Affiliation(s)
- Francesco Buccisano
- Department of Biomedicine and Prevention, Hematology, University Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.
| | - Christopher S Hourigan
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Roland B Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
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22
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Abstract
PURPOSE OF REVIEW Assessment of measurable residual disease (MRD) after treatment can identify patients with acute myeloid leukemia (AML) that are at high risk of poor outcomes. However, there is no consensus yet regarding a standardized approach to measuring MRD that is most clinically meaningful. We review multiparameter flow cytometry (MFC) and reverse transcriptase polymerase chain reaction (RT-PCR), and discuss a framework for assessing remission MRD using next-generation sequencing (NGS). RECENT FINDINGS MFC and RT-PCR may not fully capitalize on the major advances that have been made in characterizing the genetic landscape of AML, which has offered insight into the biological and clinical implications of clonal genetic architecture. NGS has increasingly been shown to provide a qualitative and quantitative assessment of MRD with significant prognostic implications. The assessment of clonal architecture by NGS may complement or extend existing approaches for MRD monitoring. Long-term serial monitoring of diagnostic, remission, and relapse samples with clinical correlation will need to be performed in order to determine the impact of various MRD patterns using this technique.
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23
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Minetto P, Guolo F, Clavio M, Kunkl A, Colombo N, Carminati E, Fugazza G, Matarese S, Guardo D, Ballerini F, Di Grazia C, Raiola AM, Cagnetta A, Cea M, Miglino M, Lemoli RM, Gobbi M. Early minimal residual disease assessment after AML induction with fludarabine, cytarabine and idarubicin (FLAI) provides the most useful prognostic information. Br J Haematol 2018; 184:457-460. [DOI: 10.1111/bjh.15106] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Paola Minetto
- Haematology Clinic; Department of Internal Medicine (DiMI); University of Genoa; Policlinico San Martino; IRCCS per l'Oncologia; Genoa Italy
| | - Fabio Guolo
- Haematology Clinic; Department of Internal Medicine (DiMI); University of Genoa; Policlinico San Martino; IRCCS per l'Oncologia; Genoa Italy
| | - Marino Clavio
- Haematology Clinic; Department of Internal Medicine (DiMI); University of Genoa; Policlinico San Martino; IRCCS per l'Oncologia; Genoa Italy
| | - Annalisa Kunkl
- Clinical Flow Cytometry Unit; Anatomic Pathology; Policlinico San Martino; IRCCS per l'Oncologia; Genoa Italy
| | - Nicoletta Colombo
- Haematology Clinic; Department of Internal Medicine (DiMI); University of Genoa; Policlinico San Martino; IRCCS per l'Oncologia; Genoa Italy
| | - Enrico Carminati
- Haematology Clinic; Department of Internal Medicine (DiMI); University of Genoa; Policlinico San Martino; IRCCS per l'Oncologia; Genoa Italy
| | - Giuseppina Fugazza
- Haematology Clinic; Department of Internal Medicine (DiMI); University of Genoa; Policlinico San Martino; IRCCS per l'Oncologia; Genoa Italy
| | - Simona Matarese
- Haematology Clinic; Department of Internal Medicine (DiMI); University of Genoa; Policlinico San Martino; IRCCS per l'Oncologia; Genoa Italy
| | - Daniela Guardo
- Haematology Clinic; Department of Internal Medicine (DiMI); University of Genoa; Policlinico San Martino; IRCCS per l'Oncologia; Genoa Italy
| | - Filippo Ballerini
- Haematology Clinic; Department of Internal Medicine (DiMI); University of Genoa; Policlinico San Martino; IRCCS per l'Oncologia; Genoa Italy
| | - Carmen Di Grazia
- Division of Haematology and Bone Marrow Transplantation; Policlinico San Martino; IRCCS per l'Oncologia; Genoa Italy
| | - Anna M. Raiola
- Division of Haematology and Bone Marrow Transplantation; Policlinico San Martino; IRCCS per l'Oncologia; Genoa Italy
| | - Antonia Cagnetta
- Haematology Clinic; Department of Internal Medicine (DiMI); University of Genoa; Policlinico San Martino; IRCCS per l'Oncologia; Genoa Italy
| | - Michele Cea
- Haematology Clinic; Department of Internal Medicine (DiMI); University of Genoa; Policlinico San Martino; IRCCS per l'Oncologia; Genoa Italy
| | - Maurizio Miglino
- Haematology Clinic; Department of Internal Medicine (DiMI); University of Genoa; Policlinico San Martino; IRCCS per l'Oncologia; Genoa Italy
| | - Roberto M. Lemoli
- Haematology Clinic; Department of Internal Medicine (DiMI); University of Genoa; Policlinico San Martino; IRCCS per l'Oncologia; Genoa Italy
| | - Marco Gobbi
- Haematology Clinic; Department of Internal Medicine (DiMI); University of Genoa; Policlinico San Martino; IRCCS per l'Oncologia; Genoa Italy
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Gomez-Arteaga A, Guzman ML. Minimal Residual Disease in Acute Myeloid Leukemia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1100:111-125. [PMID: 30411263 DOI: 10.1007/978-3-319-97746-1_7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Monitoring measurable (minimal) residual disease (MRD) in acute myeloid leukemia (AML) has greatly increased our ability to assess chemosensisitivity to treatment as well as the duration of treatment responses. There is strong evidence to support its prognostic value for long-term outcomes at different time points and across assays and targets. It's role as a surrogate endpoint to define risk-adapted strategies is still under evaluation. In this chapter, we will discuss the definition of MRD in AML, the potential contribution of leukemia stem cells (LSCs) to MRD and we will review all the current approaches to assess residual disease including the 2018 European Leukemia Network (ELN) working group recommendations for MRD standardization in AML. In addition, a summary of MRD studies associated to prognosis will be described.
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Affiliation(s)
- Alexandra Gomez-Arteaga
- Department of Medicine, Division of Hematology and Oncology, Weill Cornell Medicine - New York Presbyterian Hospital, New York, NY, USA
| | - Monica L Guzman
- Department of Medicine, Division of Hematology and Oncology, Weill Cornell Medicine - New York Presbyterian Hospital, New York, NY, USA.
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25
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Nomdedéu JF, Esquirol A, Carricondo M, Pratcorona M, Hoyos M, Garrido A, Rubio M, Bussaglia E, García-Cadenas I, Estivill C, Brunet S, Martino R, Sierra J. Bone Marrow WT1 Levels in Allogeneic Hematopoietic Stem Cell Transplantation for Acute Myelogenous Leukemia and Myelodysplasia: Clinically Relevant Time Points and 100 Copies Threshold Value. Biol Blood Marrow Transplant 2018; 24:55-63. [DOI: 10.1016/j.bbmt.2017.09.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/05/2017] [Indexed: 01/08/2023]
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26
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Candoni A, De Marchi F, Zannier ME, Lazzarotto D, Filì C, Dubbini MV, Rabassi N, Toffoletti E, Lau BW, Fanin R. High prognostic value of pre-allogeneic stem cell transplantation minimal residual disease detection by WT1 gene expression in AML transplanted in cytologic complete remission. Leuk Res 2017; 63:22-27. [PMID: 29096332 DOI: 10.1016/j.leukres.2017.10.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/24/2017] [Accepted: 10/26/2017] [Indexed: 11/17/2022]
Abstract
We analyzed the outcome of allogeneic stem cell transplantation (allo-SCT) in acute myeloid leukemia (AML) patients according to molecular Minimal Residual Disease (MRD) status prior to allo-SCT. MRD was assessed by the quantitative expression of the pan-leukemic marker Wilms' tumor (WT1) gene, according to the validated LeukemiaNet method. Between 2005 and 2016, 122 consecutive AML patients, WT1 positive at diagnosis, received allo-SCT in cytologic complete remission (cCR). The median age at SCT was 53 years (range 18-70). Quantitative analysis of WT1 gene expression (bone marrow samples) was available in all cases both at diagnosis (100% of samples overexpressed WT1 with a mean of 8607±8187 copies/104 Abelson) and immediately before allo-SCT. Eighty one cases (66%) were MRD-WT1 negative (WT1 <250 copies) and 41/122 (44%) cases were MRD-WT1 positive (WT1 >250 copies) prior to allo-SCT. We evaluated post-SCT overall survival (OS), disease free survival (DFS) and relapse rate (RR), according to MRD-WT1 status pre-SCT. Both post-allo-SCT OS and DFS were significantly improved in patients who were MRD-WT1 negative at the time of SCT compared with those who were MRD-WT1 positive, with a median OS and DFS not reached in the MRD-WT1 negative group and 9 and 8 months, respectively, in the WT1 positive group (OS log-rank p<0.0001; hazard ratio [HR] 3.9, 95% confidence interval [95% CI] 2.0-7.38; DFS log-rank p<0.0001; HR 3.73, 95% CI 2.0-6.72). The RR after SCT was 15% (12/81) in pre-SCT MRD-WT1 negative cases and 44% (18/41) in MRD-WT1 positive cases (p=0.00073). Univariate analysis showed that MRD-WT1 negativity pre-SCT and grade <2 acute GVHD were significant prognostic factors for improved OS and DFS. However multivariate analysis showed MRD-WT1 negativity pre-SCT was the only independent prognostic factor for improved OS and DFS. These data show that pre allo-SCT molecular MRD evaluation using WT1 expression is a powerful predictor of post allo-SCT outcomes in AML undergoing SCT in cCR. Patients with both cCR and MRD-WT1 negativity before SCT have a very good outcome with lower RR and improved OS. The pre allo-SCT MRD-WT1 stratification in AML is a valuable tool to identify patients at high risk of post-SCT relapse, and can influence conditioning regimen intensification and/or post-SCT preemptive strategies.
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Affiliation(s)
- Anna Candoni
- Division of Hematology and SCT, University Hospital, Udine, Udine, Italy.
| | - Federico De Marchi
- Division of Hematology and SCT, University Hospital, Udine, Udine, Italy
| | | | - Davide Lazzarotto
- Division of Hematology and SCT, University Hospital, Udine, Udine, Italy
| | - Carla Filì
- Division of Hematology and SCT, University Hospital, Udine, Udine, Italy
| | | | - Nicholas Rabassi
- Division of Hematology and SCT, University Hospital, Udine, Udine, Italy
| | | | - Bonnie W Lau
- Department of Pediatric Hematology/Oncology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Renato Fanin
- Division of Hematology and SCT, University Hospital, Udine, Udine, Italy
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