Open AccessAcute myeloid leukemia: negative prognostic impact of early blast persistence can be in part overcome by a later remission prior to post-induction therapy
Author(s) -
Jana Ihlow,
Sophia Gross,
Leonie Busack,
Anne Flörcken,
Julia Jesse,
Michaela Schwarz,
Nina Rosa Neuendorff,
AnnChristin von Brünneck,
Ioannis Anagnostopoulos,
Seval Türkmen,
Igor Wolfgang Blau,
Thomas Burmeister,
David Horst,
Lars Bullinger,
Jörg Westermann
Publication year - 2021
Publication title -
haematologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.782
H-Index - 142
eISSN - 1592-8721
pISSN - 0390-6078
DOI - 10.3324/haematol.2021.279134
Subject(s) - medicine , myeloid leukemia , chemotherapy , induction chemotherapy , oncology , hematopoietic stem cell transplantation , retrospective cohort study , leukemia , disease , minimal residual disease , bone marrow , myeloid
In acute myeloid leukemia (AML), there is an ongoing debate on the prognostic value of the early bone marrow (BM) assessment in patients receiving intensive therapy. In this retrospective study, we have analyzed the prognostic impact of the early response in 1008 newly diagnosed AML patients, who were treated at our institution with intensive chemotherapy followed by consolidation chemotherapy and/or allogeneic hematopoietic stem cell transplantation (allo-HSCT). We found that early blast persistence has an independent negative prognostic impact on overall survival (OS), event-free survival (EFS) and relapsefree survival (RFS). This negative prognostic impact may only be overcome in patients showing at least a partial remission at the early BM assessment and who subsequently achieve blast clearance by additional induction chemotherapy prior to consolidation therapy with allo-HSCT. In accordance, we propose that the time slope of remission is an additional leukemia-related dynamic parameter that reflects chemosensitivity and thus may inform postinduction therapy decision-making. In addition to patient-related factors, European LeukemiaNet (ELN) risk group, measurable residual disease (MRD) monitoring and donor availability, this may particularly apply to ELN intermediate risk patients, in whom a decision between consolidation chemotherapy and allo-HSCT remains challenging in many cases.