CD25 expression and outcomes in older patients with acute myelogenous leukemia treated with plerixafor and decitabine

Abstract

We investigated CD25 expression in older (≥60 years) patients with new acute myelogenous leukemia treated with decitabine and plerixafor. Patients resistant to therapy or survival ≤1 year had significantly higher percentages of CD25^pos myeloid blasts in baseline bone marrow. CD25^pos patients had an increased odds of resistance compared to CD25^neg patients (p = .015). In univariate analysis, we found CD25^pos patients had inferior survival compared to CD25^neg (p = .002). In patients with intermediate risk cytogenetics, CD25^pos status stratified patients associating with inferior survival (p = .002). In multivariable analysis, CD25 and TP53 mutations trended towards predicting remission to therapy but were not predictive of survival. Only remission status, ASXL1 and TET2 mutations were found to independently predict overall survival (OS). We conclude CD25 expression identifies patients at risk for resistance to hypomethylating chemotherapy but does not independently predict OS in an older AML population treated with decitabine and plerixafor.

Trial registration: ClinicalTrials.gov NCT01352650.

Keywords: AML; CD25; decitabine; drug resistance; prognostication.

Figure 1

CD25 expression status and mutational profile of 55 sequenced patients. Patients underwent next generation sequencing using a targeted exome panel of 30 genes recurrently mutated in AML. Mutations were called if the variant allele frequency was 4%. Each column represents a single patient's profile while the top axis depicts the total number of mutations per patient. Gene names are represented on the right axis and the percent of patients in the cohort with that mutation depicted on the left axis. The specific type of genetic alteration is noted in the figure legend.

Figure 2

(a) Percentage of CD25^pos blasts in D0 bone marrow samples is higher in patients with survival less than one year. (b) Percentage of CD25^pos blasts in D0 bone marrow samples is higher in patients with resistance to decitabine and plerixafor induction.

Figure 3

(a) Increased CD25 expression associates with inferior overall survival. (b) Increased CD25 expression risk stratifies patients with intermediate cytogenetics but not unfavorable cytogenetics. (c) Increased CD25 expression risk stratifies patients with intermediate cytogenetics but not unfavorable cytogenetics.