Cytogenetic and molecular diagnostic characterization combined to postconsolidation minimal residual disease assessment by flow cytometry improves risk stratification in adult acute myeloid leukemia
Cytogenetic and molecular diagnostic characterization combined to postconsolidation minimal residual disease assessment by flow cytometry improves risk stratification in adult acute myeloid leukemia
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DOI：
10.1182/blood-2009-12-258178
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发表时间：
2010-09-30
期刊：
影响因子：
20.3
通讯作者：
Venditti, Adriano
中科院分区：
文献类型：
--
作者：
Buccisano, Francesco;Maurillo, Luca;Venditti, Adriano
采用流式细胞术对143例具有可用核型(K)和FLT3基因突变状态的成年急性髓性白血病（AML）患者进行最小残留病（MRD）评估。22例（16%）患者为良好风险K， 115例（80%）为中等风险K， 6例（4%）为低风险K；129例中有19例（15%）携带FLT3-ITD突变。考虑到巩固后MRD状态，MRD-的好/中危K患者的4年无复发生存率（RFS）分别为70%和63%，总生存率（OS）分别为84%和67%。MRD+的好、中危K患者4年RFS分别为15%和17%，OS分别为38%和23%（所有比较P < 0.001）。达到MRD-状态的FLT3野生型患者的预后优于MRD+患者（4年RFS， 54% vs 17% P < 0.001； OS, 60% vs 23%, P = 0.002）。这种方法在2组中重新定义了细胞遗传学/遗传学类别：(1)低风险，包括良好/中等K-MRD- 4年RFS和OS分别为58%和73%；(2)高风险，包括低风险K、FLT3-ITD突变病例、良好/中度K- mrd +类别，RFS和OS分别为22%和17%（所有比较P < 0.001）。在AML中，基线预后指标和MRD的综合评估可改善风险评估并优化缓解后治疗。[血液。2010;116(13):2295-2303]
A total of 143 adult acute myeloid leukemia (AML) patients with available karyotype (K) and FLT3 gene mutational status were assessed for minimal residual disease (MRD) by flow cytometry. Twenty-two (16%) patients had favorable, 115 (80%) intermediate, and 6 (4%) poor risk K; 19 of 129 (15%) carried FLT3-ITD mutation. Considering post-consolidation MRD status, patients with good/intermediate-risk K who were MRD- had 4-year relapse-free survival (RFS) of 70% and 63%, and overall survival (OS) of 84% and 67%, respectively. Patients with good-and intermediate-risk K who were MRD+ had 4-year RFS of 15% and 17%, and OS of 38% and 23%, respectively (P < .001 for all comparisons). FLT3 wild-type patients achieving an MRD- status, had a better outcome than those who remained MRD+ (4-year RFS, 54% vs 17% P < .001; OS, 60% vs 23%, P = .002). Such an approach redefined cytogenetic/genetic categories in 2 groups: (1) low-risk, including good/intermediate K-MRD- with 4-year RFS and OS of 58% and 73%, respectively; and (2) high risk, including poor-risk K, FLT3-ITD mutated cases, good/intermediate K-MRD+ categories, with RFS and OS of 22% and 17%, respectively (P < .001 for all comparisons). In AML, the integrated evaluation of baseline prognosticators and MRD improves risk-assessment and optimizes postremission therapy. (Blood. 2010; 116(13):2295-2303)