Highlighting the Prognostic Importance of Measurable Residual Disease Among Acute Myeloid Leukemia Risk Factors

• Published in: Turkish journal of haematology Vol. 38; no. 2; pp. 111 - 118
• Main Authors: Narlı Özdemir, Zehra, Şahin, Uğur, Dalva, Klara, Baltacı, Mehmet Akif, Uslu, Atilla, Öztürk, Cemaleddin, Cengiz Seval, Güldane, Toprak, Selami Koçak, Kurt Yüksel, Meltem, Topçuoğlu, Pervin, Arslan, Önder, Özcan, Muhit, Beksaç, Meral, İlhan, Osman, Gürman, Günhan, Civriz Bozdağ, Sinem
• Format: Journal Article
• Language: English
• Published: Istanbul Türk Hematoloji Derneği 01-01-2021; Galenos Publishing House; Galenos Publishing
• Subjects: acute myeloid leukemia; Leukemia; measurable residual disease; multiparameter flow cytometry; Remission (Medicine); Tıp; Transplants & implants; İstanbul; Türkiye; Ölçülebilir kalıntı hastalık; Measurable residual disease; Multiparameter flow cytometry; Acute myeloid leukemia; Akut myeloid lösemi; Çok renkli akım sitometri
• ISSN: 1300-7777; 1308-5263
• DOI: 10.4274/tjh.galenos.2020.2020.0157

Objective: The optimal timing of measurable residual disease (MRD)
evaluation in acute myeloid leukemia (AML) patients has not been
well defined yet. We aimed to investigate the impact of MRD in
pre- and post-allogeneic hematopoietic stem cell transplantation
(AHSCT) periods on prognostic parameters.
Materials and Methods: Seventy-seven AML patients who underwent
AHSCT in complete morphological remission were included. MRD
analyses were performed by 10-color MFC and 10-4 was defined as
positive. Relapse risk and survival outcomes were assessed based on
pre- and post-AHSCT MRD positivity.
Results: The median age of the patients was 46 (range: 18-71)
years, and 41 (53.2%) were male while 36 (46.8%) were female. The
median follow-up after AHSCT was 12.2 months (range: 0.2-73.0).
The 2-year overall survival (OS) in the entire cohort was 37.0%, with
a significant difference between patients who were MRD-negative
and MRD-positive before AHSCT, estimated as 63.0% versus 16.0%,
respectively (p=0.005). MRD positivity at +28 days after AHSCT was
also associated with significantly inferior 2-year OS when compared
to MRD negativity (p=0.03). The risk of relapse at 1 year was 2.4 times
higher (95% confidence interval: 1.1-5.6; p=0.04) in the pre-AHSCT
MRD-positive group when compared to the MRD-negative group
regardless of other transplant-related factors, including pre-AHSCT
disease status (i.e., complete remission 1 and 2). Event-free survival
(EFS) was significantly shorter in patients who were pre-AHSCT
MRD-positive (p=0.016). Post-AHSCT MRD positivity was also related
to an increased relapse risk. OS and EFS were significantly inferior
among MRD-positive patients at +28 days after AHSCT (p=0.03 and
p=0.019).
Conclusion: Our results indicate the importance of MRD before and
after AHSCT independently of other factors.