scholarly journals Comparison of minimal residual disease as outcome predictor for AML patients in first complete remission undergoing myeloablative or nonmyeloablative allogeneic hematopoietic cell transplantation

Leukemia ◽  
2014 ◽  
Vol 29 (1) ◽  
pp. 137-144 ◽  
Author(s):  
R B Walter ◽  
B Gyurkocza ◽  
B E Storer ◽  
C D Godwin ◽  
J M Pagel ◽  
...  
Keyword(s):  
Complete Remission ◽  
Minimal Residual Disease ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Residual Disease ◽  
Hematopoietic Cell ◽  
Allogeneic Hematopoietic Cell Transplantation ◽  
Outcome Predictor ◽  
Minimal Residual ◽  
First Complete Remission

scholarly journals How I treat measurable (minimal) residual disease in acute leukemia after allogeneic hematopoietic cell transplantation

Blood ◽  
2020 ◽  
Vol 135 (19) ◽  
pp. 1639-1649 ◽  
Author(s):  
Alexandros Spyridonidis
Keyword(s):  
Acute Leukemia ◽  
Minimal Residual Disease ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Residual Disease ◽  
Hematopoietic Cell ◽  
Allogeneic Hematopoietic Cell Transplantation ◽  
Leukemia Relapse ◽  
Minimal Residual

Abstract Although allogeneic hematopoietic cell transplantation (allo-HCT) is currently the standard curative treatment of acute leukemia, relapse remains unacceptably high. Measurable (minimal) residual disease (MRD) after allo-HCT may be used as a predictor of impending relapse and should be part of routine follow-up for transplanted patients. Patients with MRD may respond to therapies aiming to unleash or enhance the graft-versus-leukemia effect. However, evidence-based recommendations on how to best implement MRD testing and MRD-directed therapy after allo-HCT are lacking. Here, I describe our institutional approach to MRD monitoring for preemptive MRD-triggered intervention, using patient scenarios to illustrate the discussion.

scholarly journals Significance of minimal residual disease before myeloablative allogeneic hematopoietic cell transplantation for AML in first and second complete remission

Blood ◽  
2013 ◽  
Vol 122 (10) ◽  
pp. 1813-1821 ◽  
Author(s):  
Roland B. Walter ◽  
Sarah A. Buckley ◽  
John M. Pagel ◽  
Brent L. Wood ◽  
Barry E. Storer ◽  
...  
Keyword(s):  
Complete Remission ◽  
Minimal Residual Disease ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Residual Disease ◽  
Adverse Outcome ◽  
Negative Impact ◽  
Hematopoietic Cell ◽  
Key Points ◽  
Minimal Residual

Key Points The negative impact of pre-HCT flow cytometrically determined MRD is similar for AML in CR1 and CR2. Even minute levels of MRD (≤0.1%) are associated with adverse outcome.

Comparison Of Minimal Residual Disease As Outcome Predictor For AML Patients In First Complete Remission Undergoing Myeloablative Or Nonmyeloablative Allogeneic Hematopoietic Cell Transplantation

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1317-1317
Author(s):  
Roland B. Walter ◽  
Boglarka Gyurkocza ◽  
Barry E. Storer ◽  
John M. Pagel ◽  
Sarah A. Buckley ◽  
...  
Keyword(s):  
Complete Remission ◽  
Minimal Residual Disease ◽  
Cell Transplantation ◽  
Blood Count ◽  
Hematopoietic Cell Transplantation ◽  
Residual Disease ◽  
Negative Impact ◽  
Minimal Residual ◽  
First Complete Remission ◽  
Count Recovery

Abstract Background Minimal residual disease (MRD) has been recognized as a strong, independent predictor of increased relapse risk and poor outcome for patients with acute myeloid leukemia (AML) in first complete remission (CR) undergoing myeloablative (MA) allogeneic hematopoietic cell transplantation (HCT). As the relationship between MRD and outcome is less studied for AML patients undergoing nonmyeloablative (NMA) HCT, we herein conducted a comparative analysis to assess this association relative to that seen in MA HCT. Patients and Methods We studied 272 consecutive patients receiving NMA (n=63) or MA (n=209) HCT for AML in first CR or CR with incomplete blood count recovery (CRi) between May 2006 and May 2012. Pre-HCT bone marrow aspirates were obtained in all patients and analyzed by routine karyotyping and ten-color flow cytometry. MRD was identified as a cell population showing deviation from normal antigen expression patterns as compared with normal or regenerating marrow. Any level of residual disease was considered MRDpos. Data are current as of April 1, 2013. Results Baseline characteristics of the study cohort are summarized in Table 1. Patients undergoing NMA HCT were significantly older than those undergoing MA HCT (p<0.001), more often were male (p=0.03), had more comorbidities (p<0.001), more often had secondary leukemias (p=0.05), and more often had incomplete blood count recovery at the time of HCT (p<0.001). Sixteen NMA patients (25.4%) and 40 MA patients (19.1%) were MRDpos, with medians of 0.31% (range: 0.02-2.8%) and 0.29% (0.007-7.8%) abnormal blasts for MRDpos NMA and MA patients, respectively. Three-year estimates of relapse among NMA patients were 31% (18-44%) and 64% (35-82%) for MRDneg and MRDpos patients, respectively, and 21% (15-29%) and 53% (37-68%), respectively, among MA patients (Figure 1A). Among NMA patients, the 3-year estimates of OS were 53% (37-66%) and 49% (21-73%) for MRDneg and MRDpos patients, respectively; among MA patients, 3-year OS was estimated to be 74% (65-80%) and 36% (20-51%), respectively (Figure 1B). This unexpectedly similar outcome in OS for MRDneg and MRDpos NMA patients was largely accounted for by the considerably higher non-relapse mortality (NRM) in MRDneg patients (29% [17-42%]) compared to MRDpos patients (0%), which was the reverse of findings in MRDneg and MRDpos MA patients (8% [5-13%] vs. 21% [10-34%], respectively; Figure 1C). Hazard ratio analysis confirmed a highly statistically significant difference between MA and NMA patients in the association of MRD status with NRM (p<0.001), but not with relapse (p=0.45). There was also evidence of a differential association of MRD status with OS (p=0.03). After adjustment for HCT type (NMA vs MA), age, cytogenetic risk, type of AML, number of cycles of induction chemotherapy, type of consolidation therapy, pre-HCT karyotype, pre-HCT blood counts, and HCT-comorbidity index, being MRDpos was associated with increased risk of relapse (HR=3.31 [1.91-5.73], p<0.001). Conclusion The negative impact of MRD on post-transplant relapse risk among AML patients in CR1 undergoing NMA HCT is similar to the negative impact seen in patients undergoing MA HCT. Because of the high rate of NRM among MRDneg NMA patients the survival difference between MRDneg and MRDpos patients was much larger in MA than NMA patients in this analysis. Disclosures: No relevant conflicts of interest to declare.

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