Comparative value of post-remission treatment in cytogenetically normal AML subclassified by NPM1 and FLT3-ITD allelic ratio

被引：51

作者：

Versluis, J. ^{[1
]}

't Hout, F. E. M. In ^{[2
,3
]}

Devillier, R. ^{[1
]}

van Putten, W. L. J. ^{[4
]}

Manz, M. G. ^{[5
]}

Vekemans, M-C ^{[6
]}

Legdeur, M-C ^{[7
]}

Passweg, J. R. ^{[8
]}

Maertens, J. ^{[9
]}

Kuball, J. ^{[10
]}

Biemond, B. J. ^{[11
]}

Valk, P. J. M. ^{[1
]}

van der Reijden, B. A. ^{[3
]}

Meloni, G. ^{[12
]}

Schouten, H. C. ^{[13
]}

Vellenga, E. ^{[14
]}

Pabst, T. ^{[15
]}

Willemze, R. ^{[16
]}

Lowenberg, B. ^{[1
]}

Ossenkoppele, G. ^{[17
]}

Baron, F. ^{[18
]}

Huls, G. ^{[2
]}

Cornelissen, J. J. ^{[1
]}

机构：

[1] Erasmus Univ, Med Ctr, Inst Canc, Dept Hematol, Groene Hilledijk 301, NL-3075 EA Rotterdam, Netherlands

[2] Radboud Univ Nijmegen, Med Ctr, Dept Hematol, Nijmegen, Netherlands

[3] Radboud Univ Nijmegen, Med Ctr, Hematol Lab, Dept Lab Med, Nijmegen, Netherlands

[4] Erasmus Univ, Med Ctr, Inst Canc, HOVON Data Ctr,Clin Trial Ctr, Rotterdam, Netherlands

[5] Univ Zurich Hosp, Div Hematol, Zurich, Switzerland

[6] Hop St Luc, Dept Hematol, Brussels, Belgium

[7] Med Spectrum Twente, Dept Hematol, Enschede, Netherlands

[8] Univ Basel Hosp, Stem Cell Transplant Team, Basel, Switzerland

[9] Univ Hosp Gasthuisberg, Dept Hematol, Leuven, Belgium

[10] Univ Med Ctr, Dept Immunol & Hematol, Utrecht, Netherlands

[11] Univ Amsterdam, Acad Med Ctr, Dept Hematol, Amsterdam, Netherlands

[12] Sapienza Univ, Dept Cellular Biotechnol & Hematol, Rome, Italy

[13] Univ Hosp Maastricht, Dept Hematol, Maastricht, Netherlands

[14] Univ Groningen, Univ Med Ctr Groningen, Dept Hematol, Groningen, Netherlands

[15] Univ Hosp Bern, Inselspital, Dept Med Oncol, Bern, Switzerland

[16] Leiden Univ, Med Ctr, Dept Hematol, Leiden, Netherlands

[17] Vrije Univ Amsterdam Med Ctr, Dept Hematol, Amsterdam, Netherlands

[18] Univ Liege, Dept Hematol, Liege, Belgium

来源：

LEUKEMIA | 2017年 / 31卷 / 01期

关键词：

ACUTE MYELOID-LEUKEMIA; STEM-CELL TRANSPLANTATION; MINIMAL RESIDUAL DISEASE; INTERNAL TANDEM DUPLICATION; ACUTE MYELOGENOUS LEUKEMIA; NO-DONOR ANALYSIS; UK MRC AML-10; REDUCED-INTENSITY; CONDITIONING REGIMEN; PROGNOSTIC IMPACT;

D O I：

10.1038/leu.2016.183

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Post-remission treatment (PRT) in patients with cytogenetically normal (CN) acute myeloid leukemia (AML) in first complete remission (CR1) is debated. We studied 521 patients with CN-AML in CR1, for whom mutational status of NPM1 and FLT3-ITD was available, including the FLT3-ITD allelic ratio. PRT consisted of reduced intensity conditioning (RIC) allogeneic hematopoietic stem cell transplantation (alloHSCT) (n = 68), myeloablative conditioning (MAC) alloHSCT (n = 137), autologous hematopoietic stem cell transplantation (autoHSCT) (n = 168) or chemotherapy (n = 148). Favorable overall survival (OS) was found for patients with mutated NPM1 without FLT3-ITD (71 +/- 4%). Outcome in patients with a high FLT3-ITD allelic ratio appeared to be very poor with OS and relapse-free survival (RFS) of 23 +/- 8% and 12 +/- 6%, respectively. Patients with wild-type NPM1 without FLT3-ITD or with a low allelic burden of FLT3-ITD were considered as intermediate-risk group because of similar OS and RFS at 5 years, in which PRT by RIC alloHSCT resulted in better OS and RFS as compared with chemotherapy (hazard ratio (HR) 0.56, P = 0.022 and HR 0.50, P = 0.004, respectively) or autoHSCT (HR 0.60, P = 0.046 and HR 0.60, P = 0.043, respectively). The lowest cumulative incidence of relapse (23 +/- 4%) was observed following MAC alloHSCT. These results suggest that alloHSCT may be preferred in patients with molecularly intermediate-risk CN-AML, while the choice of conditioning type may be personalized according to risk for non-relapse mortality.

引用

页码：26 / 33

页数：8

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