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MRD-directed risk-stratification treatment may improve outcome of t (8;21) AML in the first complete remission: results from AML05 Multicenter Trial

Hong-Hu Zhu, Xiao-Hui Zhang, Ya-Zhen Qin, Dai-Hong Liu, Hao Jiang, Huan Chen, Qian Jiang, Lan-Ping Xu, Jin Lu, Wei Han, Li Bao, Yu Wang, Yu-Hong Chen, Jing-Zhi Wang, Feng-Rong Wang, Yue-Yun Lai, Jun-Yue Chai, Li-Ru Wang, Yan-Rong Liu, Kai-Yan Liu, Bin Jiang and Xiao-Jun Huang

Key points

  • Risk-Stratification treatment of t (8;21) acute myeloid leukemia could decrease relapse and improve long-term survival.

  • Allo-HSCT benefited high-risk , but impaired the survival of low-risk patients

Abstract

We aimed to improve outcome of t (8;21) acute myeloid leukemia (AML) in first complete remission (CR1) by applying risk-directed therapy based on minimal residual disease (MRD) determined by RUNX1/RUNX1T1 transcript levels. Risk-directed therapy included recommending allogeneic hematopoietic stem-cell transplantation (allo-HSCT) for high-risk and chemotherapy/autologous-HSCT(auto-HSCT) for low-risk patients. Among 116 eligible patients, MRD status after second consolidation rather than induction or first consolidation could discriminate high risk relapse patients (P= .001). Allo-HSCT could reduce relapse and improve survival compared to chemotherapy for high-risk patients (cumulative incidence of relapse (CIR) 22.1% vs 78.9%, P< .0001; disease-free survival (DFS) 61.7% vs 19.6%, P= .001), while chemotherapy/auto-HSCT achieved a low relapse rate (5.3%) and high DFS (94.7%) for low-risk patients. Based on the MRD after second consolidation, sixty-nine patients receiving risk-directed therapy achieved 5 year CIR of 15.0%, DFS of 74.7%, and overall-survival (OS) of 82.7%. Multivariate analysis revealed that MRD status and treatment choice were independent prognostic factors for relapse, DFS and OS. We concluded that MRD status after second consolidation may be the best timing for treatment choice. MRD-directed risk-stratification treatment may improve the outcome of t (8;21) AML in CR1. (registered with the ChiCTR-OCH-12002406)

  • Submitted November 29, 2012.
  • Accepted March 19, 2013.