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Quality of Response in Acute Myeloid Leukemia: The Role of Minimal Residual Disease
Open AccessArticle

Molecular Detection of Minimal Residual Disease before Allogeneic Stem Cell Transplantation Predicts a High Incidence of Early Relapse in Adult Patients with NPM1 Positive Acute Myeloid Leukemia

1
Hematology and Bone Marrow Transplant Unit, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, 24127 Bergamo, Italy
2
Department of Oncology and Hematology, Universita’ degli Studi di Milano, 20122 Milano, Italy
*
Author to whom correspondence should be addressed.
Cancers 2019, 11(10), 1455; https://doi.org/10.3390/cancers11101455
Received: 27 August 2019 / Revised: 20 September 2019 / Accepted: 23 September 2019 / Published: 28 September 2019
(This article belongs to the Special Issue Acute Myeloid Leukemia)
We analyzed the impact of alloHSCT in a single center cohort of 89 newly diagnosed NPM1mut AML patients, consecutively treated according to the Northern Italy Leukemia Group protocol 02/06 [NCT00495287]. After two consolidation cycles, the detection of measurable residual disease (MRD) by RQ-PCR was strongly associated with an inferior three-year overall survival (OS, 45% versus 84%, p = 0.001) and disease-free survival (DFS, 44% versus 76%, p = 0.006). In MRD-negative patients, post-remissional consolidation with alloHSCT did not provide a significant additional benefit over a conventional chemotherapy in terms of overall survival [OS, 89% (95% CI 71–100%) versus 81% (95% CI 64–100%), p = 0.59] and disease-free survival [DFS, 80% (95% CI 59–100%) versus 75% (95% CI 56–99%), p = 0.87]. On the contrary, in patients with persistent MRD positivity, the three-year OS and DFS were improved in patients receiving an alloHSCT compared to those allocated to conventional chemotherapy (OS, 52% versus 31%, p = 0.45 and DFS, 50% versus 17%, p = 0.31, respectively). However, in this group of patients, the benefit of alloHSCT was still hampered by a high incidence of leukemia relapse during the first year after transplantation (43%, 95% CI 25–60%). Consolidative alloHSCT improves outcomes compared to standard chemotherapy in patients with persistent NPM1mut MRD positivity, but in these high-risk patients, the significant incidence of leukemia relapse must be tackled by post-transplant preemptive treatments. View Full-Text
Keywords: acute myeloid leukemia; nucleophosmin (NPM1); allogeneic stem cell transplantation acute myeloid leukemia; nucleophosmin (NPM1); allogeneic stem cell transplantation
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Lussana, F.; Caprioli, C.; Stefanoni, P.; Pavoni, C.; Spinelli, O.; Buklijas, K.; Michelato, A.; Borleri, G.; Algarotti, A.; Micò, C.; Grassi, A.; Intermesoli, T.; Rambaldi, A. Molecular Detection of Minimal Residual Disease before Allogeneic Stem Cell Transplantation Predicts a High Incidence of Early Relapse in Adult Patients with NPM1 Positive Acute Myeloid Leukemia. Cancers 2019, 11, 1455.

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