1. Inicio
  2. Publicaciones
  3. Measurable residual disease in elderly acute myeloid leukemia: results from the PETHEMA-FLUGAZA phase 3 clinical trial.

Measurable residual disease in elderly acute myeloid leukemia: results from the PETHEMA-FLUGAZA phase 3 clinical trial.

Fecha de publicación:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Simoes C
  • Paiva B
  • Bergua JM
  • Vives S
  • Algarra L
  • Tormo M
  • Martinez P
  • Serrano J
  • Herrera P
  • Ramos F
  • Salamero O
  • Lavilla E
  • Gil C
  • Lopez JL
  • Vidriales MB
  • Labrador J
  • Falantes JF
  • Sayas MJ
  • Ayala R
  • Martinez-Lopez J
  • Villar S
  • Calasanz MJ
  • Prosper F
  • San-Miguel JF

Grupos

Abstract

The value of measurable residual disease (MRD) in elderly patients with acute myeloid leukemia (AML) is inconsistent between those treated with intensive vs hypomethylating drugs, and unknown after semi-intensive therapy. We investigated the role of MRD in refining complete remission (CR) and treatment duration in the phase 3 FLUGAZA clinical trial, which randomized 283 elderly AML patients to induction and consolidation with fludarabine plus cytarabine (FLUGA) vs 5-azacitidine. After consolidation, patients continued treatment if MRD was =0.01% or stopped if MRD was <0.01%, as assessed by multidimensional flow cytometry (MFC). On multivariate analysis including genetic risk and treatment arm, MRD status in patients achieving CR (N = 72) was the only independent prognostic factor for relapse-free survival (RFS) (HR, 3.45; P = .002). Achieving undetectable MRD significantly improved RFS of patients with adverse genetics (HR, 0.32; P = .013). Longer overall survival was observed in patients with undetectable MRD after induction though not after consolidation. Although leukemic cells from most patients displayed phenotypic aberrancies vs their normal counterpart (N = 259 of 265), CD34 progenitors from cases with undetectable MRD by MFC carried extensive genetic abnormalities identified by whole-exome sequencing. Interestingly, the number of genetic alterations significantly increased from diagnosis to MRD stages in patients treated with FLUGA vs 5-azacitidine (2.2-fold vs 1.1-fold; P = .001). This study supports MRD assessment to refine CR after semi-intensive therapy or hypomethylating agents, but unveils that improved sensitivity is warranted to individualize treatment and prolong survival of elderly AML patients achieving undetectable MRD.

© 2021 by The American Society of Hematology.

Datos de la publicación

ISSN/ISSNe:
2473-9529, 2473-9537

Blood Advances  ELSEVIER

Tipo:
Article
Páginas:
760-770
PubMed:
33560390
Factor de Impacto:
2,795 SCImago ℠
Cuartil:
Q1 SCImago ℠

Citas Recibidas en Web of Science: 23

Documentos

  • No hay documentos

Métricas

Filiaciones mostrar / ocultar

Keywords

  • HEMATOPOIETIC-CELL TRANSPLANTATION; OLDER PATIENTS; INTENSIVE CHEMOTHERAPY; PROGNOSTIC VALUE; MUTATIONS; AML; AGE; PREDICTION; RISK; GENE

Campos de Estudio

Compartir