Prognostic impact of early response to induction therapy as assessed by multiparameter flow cytometry in acute myeloid leukemia.
OBJECTIVE
Early response after induction therapy is an independent prognostic factor in acute myeloid leukemia (AML). We improved the identification of this parameter by implementing multiparameter flow cytometry to quantify bone marrow cells carrying leukemia-associated immunophenotypes (LAIP).


METHODS
In 106 uniformly treated patients flow cytometric analyses were performed at diagnosis and one week after induction therapy (day 16). The log-difference between LAIP-positive cells on day 1and day 16 (LD16) was determined for each patient.


RESULTS
The LD16 (median, 2.11; range, -0.37 to 4.20) was significantly correlated to CR rate, event-free survival (EFS), overall survival (OS), and relapse-free survival (RFS). Separation of patients by the median LD16 resulted in significant differences in CR rate (81% vs. 51%, p=0.002), EFS (53% at 2 years vs. median 2.8 months, p<0.0001), 2-year OS (58% vs. 43%, p=0.0133), and 2-year RFS (65% vs. 30%, p=0.0037). Multivariate analysis revealed that LD16 was an independent prognostic parameter for CR rate, EFS, and RFS.


CONCLUSIONS
Flow cytometric evaluation of early response may serve as a new response parameter in AML. It may be used for development of risk-adapted therapies. High-risk patients can be identified early after the first induction therapy and assigned alternative and salvage treatment strategies.
Kern
Wolfgang
W
Laboratory for Leukemia Diagnostics,Dept. of Internal Medicine III, University Hospital Grosshadern, Ludwig-Maximilians-University, 81366 Muenchen, Germany. wolfgang.kern@med3.med.uni-muenchen.de <wolfgang.kern@med3.med.uni-muenchen.de>
Voskova
Daniela
D
Schoch
Claudia
C
Schnittger
Susanne
S
Hiddemann
Wolfgang
W
Haferlach
Torsten
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001854:Bone Marrow Cells / Q000276:immunology*; D003561:Cytarabine / Q000627:therapeutic use; D003630:Daunorubicin / Q000627:therapeutic use; D005260:Female; D005434:Flow Cytometry / Q000379:methods*; D006801:Humans; D016130:Immunophenotyping; D007951:Leukemia, Myeloid / Q000188:drug therapy / Q000276:immunology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000627:therapeutic use; D018365:Neoplasm, Residual; D011379:Prognosis; D012074:Remission Induction / Q000379:methods; D033581:Stem Cell Transplantation; D016019:Survival Analysis; D013866:Thioguanine / Q000627:therapeutic use
D003561:Cytarabine; D008942:Mitoxantrone; D013866:Thioguanine; D003630:Daunorubicin