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. 2020 Dec 22;4(24):6117-6126.
doi: 10.1182/bloodadvances.2020002811.

Prognostic impact of complete remission with MRD negativity in patients with relapsed or refractory AML

Nicholas J Short  1 , Hind Rafei  2 , Naval Daver  1 , Hyunsoo Hwang  3 , Jing Ning  3 , Jeffrey L Jorgensen  4 , Tapan M Kadia  1 , Courtney D DiNardo  1 , Sa A Wang  4 , Elias Jabbour  1 , Uday Popat  5 , Betul Oran  5 , Jorge Cortes  1 , Marina Konopleva  1 , Musa Yilmaz  1 , Ghayas C Issa  1 , Hagop Kantarjian  1 , Farhad Ravandi  1
Affiliations

Prognostic impact of complete remission with MRD negativity in patients with relapsed or refractory AML

Nicholas J Short et al. Blood Adv. .

Erratum in

Abstract

In relapsed/refractory acute myeloid leukemia (AML), the prognostic impact of complete remission (CR) and measurable residual disease (MRD) negativity is not well established. We retrospectively analyzed 141 patients with relapsed/refractory AML who received first salvage therapy and had MRD assessed by multiparameter flow cytometry at the time of response. Patients who achieved CR with full hematologic recovery as best response vs those with incomplete hematology recovery had lower cumulative incidence of relapse (P = .01) and better relapse-free survival (P = .004) but not overall survival (P = .15); a similar trend was observed in patients who achieved MRD negativity vs those who were MRD positive (P = .01, P = .05, and P = .21, respectively). By multivariate analysis, CR and MRD negativity were each independently associated with lower cumulative incidence of relapse (P = .001 and P = .003, respectively) and better relapse-free survival (P < .001 and P = .02) but not overall survival. Patients who achieved CR with MRD negativity had the lowest rates of relapse and best survival (2-year overall survival rate, 37%), which was driven largely by lower rates of early relapse and an increased ability in this group to undergo hematopoietic stem cell transplantation (HSCT); however, post-HSCT outcomes were similar regardless of response to salvage chemotherapy. Overall, in patients with relapsed/refractory AML, CR with MRD negativity was associated with the best outcomes, supporting it as the optimal response in this setting.

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Outcomes of patients according to hematologic recovery and MRD status. CIR (A), RFS (B), and OS (C) for the entire cohort, stratified according to hematologic response to salvage chemotherapy. CIR (D), RFS (E), and OS (F) for the entire cohort, stratified according to MRD response to salvage chemotherapy.
Figure 2.
Figure 2.
Outcomes of patients according to hematologic recovery, MRD status, and subsequent HSCT. CIR (A), RFS (B), and OS (C) stratified according to CRMRD– vs lesser responses and HSCT vs no HSCT. Landmark analysis excluded patients who relapsed or died within 1.4 months from the time of response to salvage chemotherapy.
Figure 3.
Figure 3.
Outcomes of patients according to integrated hematologic and MRD response. CIR (A), RFS (B), and OS (C) for the entire cohort, stratified according to hematologic and MRD responses to salvage chemotherapy.
Figure 4.
Figure 4.
Outcomes of patients achieving CRMRD– vs lesser responses. CIR (A), RFS (B), and OS (C) for the entire cohort, stratified according to CRMRD– vs lesser responses.
See this image and copyright information in PMC

References

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