Achieving stringent CR is essential before reduced-intensity conditioning allogeneic hematopoietic cell transplantation in AML

Reduced-intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (allo-HCT) can cure patients with AML in CR. However, relapse after RIC allo-HCT may indicate heterogeneity in the stringency of CR. Strict definition of CR requires no evidence of leukemia by both morphologic and flo...

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Published inBone marrow transplantation (Basingstoke) Vol. 48; no. 11; pp. 1415 - 1420
Main Authors Ustun, C, Wiseman, A C, DeFor, T E, Yohe, S, Linden, M A, Oran, B, Burke, M, Warlick, E, Miller, J S, Weisdorf, D
Format Journal Article
LanguageEnglish
Published London Nature Publishing Group UK 01.11.2013
Nature Publishing Group
Subjects
692/699/67/1990/283/1897
692/700/565/545/576/1955
Acute myeloid leukemia
Adult
Aged
Bone marrow
Cancer regression
Cell Biology
Cohort Studies
Conditioning
Confidence intervals
Criteria
Female
Flow cytometry
Hematology
Hematopoietic Stem Cell Transplantation - methods
Hematopoietic stem cells
Heterogeneity
Humans
Immunophenotyping
Internal Medicine
Leukemia
Leukemia, Myeloid, Acute - surgery
Leukemia, Myeloid, Acute - therapy
Male
Medicine
Medicine & Public Health
Middle Aged
Neoplasm, Residual - surgery
Neoplasm, Residual - therapy
original-article
Patients
Prognosis
Public Health
Retrospective Studies
Stem cell transplantation
Stem Cells
Survival
Testing
Transplantation
Transplantation Conditioning - methods
Transplantation, Homologous
Treatment Outcome
Young Adult
AML
reduced-intensity conditioning regimen
minimal residual disease
relapse
allogeneic hematopoietic cell transplantation
CR
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Abstract Reduced-intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (allo-HCT) can cure patients with AML in CR. However, relapse after RIC allo-HCT may indicate heterogeneity in the stringency of CR. Strict definition of CR requires no evidence of leukemia by both morphologic and flow cytometric criteria. We re-evaluated 85 AML patients receiving RIC allo-HCT in CR to test if a strict definition of CR had direct implications for the outcome. These patients had leukemia immunophenotype documented at diagnosis and analyzed at allo-HCT. Eight (9.4%) had persistent leukemia by flow cytometric criteria at allo-HCT. The patients with immunophenotypic persistent leukemia had a significantly increased relapse (hazard ratio (HR): 3.7; 95% confidence interval (CI): 1.3–10.3, P =0.01) and decreased survival (HR: 2.9; 95% CI: 1.3–6.4, P <0.01) versus 77 patients in CR by both morphology and flow cytometry. However, the pre-allo-HCT bone marrow (BM) blast count (that is, 0–4%) was not significantly associated with risks of relapse or survival. These data indicate the presence of leukemic cells, but not the BM blast count affects survival. A strict morphologic and clinical lab flow cytometric definition of CR predicts outcomes after RIC allo-HCT, and therefore is critical to achieve at transplantation.
AbstractList Reduced-intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (allo-HCT) can cure patients with AML in CR. However, relapse after RIC allo-HCT may indicate heterogeneity in the stringency of CR. Strict definition of CR requires no evidence of leukemia by both morphologic and flow cytometric criteria. We re-evaluated 85 AML patients receiving RIC allo-HCT in CR to test if a strict definition of CR had direct implications for the outcome. These patients had leukemia immunophenotype documented at diagnosis and analyzed at allo-HCT. Eight (9.4%) had persistent leukemia by flow cytometric criteria at allo-HCT. The patients with immunophenotypic persistent leukemia had a significantly increased relapse (hazard ratio (HR): 3.7; 95% confidence interval (CI): 1.3-10.3, P=0.01) and decreased survival (HR: 2.9; 95% CI: 1.3-6.4, P<0.01) versus 77 patients in CR by both morphology and flow cytometry. However, the pre-allo-HCT bone marrow (BM) blast count (that is, 0-4%) was not significantly associated with risks of relapse or survival. These data indicate the presence of leukemic cells, but not the BM blast count affects survival. A strict morphologic and clinical lab flow cytometric definition of CR predicts outcomes after RIC allo-HCT, and therefore is critical to achieve at transplantation.
Reduced-intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (allo-HCT) can cure patients with AML in CR. However, relapse after RIC allo-HCT may indicate heterogeneity in the stringency of CR. Strict definition of CR requires no evidence of leukemia by both morphologic and flow cytometric criteria. We re-evaluated 85 AML patients receiving RIC allo-HCT in CR to test if a strict definition of CR had direct implications for the outcome. These patients had leukemia immunophenotype documented at diagnosis and analyzed at allo-HCT. Eight (9.4%) had persistent leukemia by flow cytometric criteria at allo-HCT. The patients with immunophenotypic persistent leukemia had a significantly increased relapse (hazard ratio (HR): 3.7; 95% confidence interval (CI):1.3-10.3, P = 0.01) and decreased survival (HR: 2.9; 95% CI: 1.3-6.4, P<0.01) versus 77 patients in CR by both morphology and flow cytometry. However, the pre-allo-HCT bone marrow (BM) blast count (that is, 0-4%) was not significantly associated with risks of relapse or survival. These data indicate the presence of leukemic cells, but not the BM blast count affects survival. A strict morphologic and clinical lab flow cytometric definition of CR predicts outcomes after RIC allo-HCT, and therefore is critical to achieve at transplantation. Bone Marrow Transplantation (2013) 48, 1415-1420 doi:10.1038/bmt.2013.124; published online 12 August 2013 Keywords: allogeneic hematopoietic cell transplantation; reduced-intensity conditioning regimen; AML; relapse; minimal residual disease; CR
Reduced-intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (allo-HCT) can cure patients with AML in CR. However, relapse after RIC allo-HCT may indicate heterogeneity in the stringency of CR. Strict definition of CR requires no evidence of leukemia by both morphologic and flow cytometric criteria. We re-evaluated 85 AML patients receiving RIC allo-HCT in CR to test if a strict definition of CR had direct implications for the outcome. These patients had leukemia immunophenotype documented at diagnosis and analyzed at allo-HCT. Eight (9.4%) had persistent leukemia by flow cytometric criteria at allo-HCT. The patients with immunophenotypic persistent leukemia had a significantly increased relapse (hazard ratio (HR): 3.7; 95% confidence interval (CI): 1.3-10.3, P=0.01) and decreased survival (HR: 2.9; 95% CI: 1.3-6.4, P&lt;0.01) versus 77 patients in CR by both morphology and flow cytometry. However, the pre-allo-HCT bone marrow (BM) blast count (that is, 0-4%) was not significantly associated with risks of relapse or survival. These data indicate the presence of leukemic cells, but not the BM blast count affects survival. A strict morphologic and clinical lab flow cytometric definition of CR predicts outcomes after RIC allo-HCT, and therefore is critical to achieve at transplantation.
Reduced-intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (allo-HCT) can cure patients with AML in CR. However, relapse after RIC allo-HCT may indicate heterogeneity in the stringency of CR. Strict definition of CR requires no evidence of leukemia by both morphologic and flow cytometric criteria. We re-evaluated 85 AML patients receiving RIC allo-HCT in CR to test if a strict definition of CR had direct implications for the outcome. These patients had leukemia immunophenotype documented at diagnosis and analyzed at allo-HCT. Eight (9.4%) had persistent leukemia by flow cytometric criteria at allo-HCT. The patients with immunophenotypic persistent leukemia had a significantly increased relapse (hazard ratio (HR): 3.7; 95% confidence interval (CI): 1.3–10.3, P =0.01) and decreased survival (HR: 2.9; 95% CI: 1.3–6.4, P <0.01) versus 77 patients in CR by both morphology and flow cytometry. However, the pre-allo-HCT bone marrow (BM) blast count (that is, 0–4%) was not significantly associated with risks of relapse or survival. These data indicate the presence of leukemic cells, but not the BM blast count affects survival. A strict morphologic and clinical lab flow cytometric definition of CR predicts outcomes after RIC allo-HCT, and therefore is critical to achieve at transplantation.
Audience Academic
Author Yohe, S
Oran, B
Miller, J S
Weisdorf, D
DeFor, T E
Burke, M
Ustun, C
Linden, M A
Wiseman, A C
Warlick, E
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reduced-intensity conditioning regimen
minimal residual disease
relapse
allogeneic hematopoietic cell transplantation
CR
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Snippet Reduced-intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (allo-HCT) can cure patients with AML in CR. However, relapse after RIC...
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SubjectTerms 692/699/67/1990/283/1897
692/700/565/545/576/1955
Acute myeloid leukemia
Adult
Aged
Bone marrow
Cancer regression
Cell Biology
Cohort Studies
Conditioning
Confidence intervals
Criteria
Female
Flow cytometry
Hematology
Hematopoietic Stem Cell Transplantation - methods
Hematopoietic stem cells
Heterogeneity
Humans
Immunophenotyping
Internal Medicine
Leukemia
Leukemia, Myeloid, Acute - surgery
Leukemia, Myeloid, Acute - therapy
Male
Medicine
Medicine & Public Health
Middle Aged
Neoplasm, Residual - surgery
Neoplasm, Residual - therapy
original-article
Patients
Prognosis
Public Health
Retrospective Studies
Stem cell transplantation
Stem Cells
Survival
Testing
Transplantation
Transplantation Conditioning - methods
Transplantation, Homologous
Treatment Outcome
Young Adult
Title Achieving stringent CR is essential before reduced-intensity conditioning allogeneic hematopoietic cell transplantation in AML
URI https://link.springer.com/article/10.1038/bmt.2013.124
https://www.ncbi.nlm.nih.gov/pubmed/23933764
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Volume 48
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