Monitoring of minimal residual disease in adult acute myeloid leukemia using peripheral blood as an alternative source to bone marrow.
OBJECTIVE
To date, bone marrow (BM) is the most common source of cells to use in order to assess minimal residual disease (MRD) in acute myeloid leukemia (AML). In the present study, we investigated whether peripheral blood (PB) could be an alternative source of cells for monitoring MRD in AML.


METHODS
Fifty patients with AML were monitored for MRD after the achievement of complete remission. Using multiparametric flow cytometry we compared the levels of MRD in 50 and 48 pairs of BM and PB after induction and consolidation, respectively.


RESULTS
After induction and consolidation therapy, the findings in BM and PB were significantly concordant (r=0.86 and 0.82, respectively, p<0.001 for both comparisons). The cut-off value of residual leukemic cells in PB which correlated with outcome was 1.5x10 (-4). Thirty-three of 43 (77%) patients with >1.5x10 (-4)residual leukemic cells in PB after induction had a relapse, whereas the seven patients with lower levels did not (p=0.0002). After consolidation, 38 patients had a level of MRD >1.5x10 (-4)and 31 (82%) had a relapse; nine out of the remaining ten patients, whose levels of MRD were below 1.5x10 (-4), are still relapse-free (p=0.00006). In multivariate analysis, PB MRD status at the end of consolidation was found to have a significant effect on relapse-free survival (p=0.036).


CONCLUSIONS
These preliminary results indicate that: (i) PB evaluation can integrate BM assessment for MRD detection in patients with AML; (ii) PB MRD status at the end of consolidation therapy may provide useful prognostic information.
Maurillo
Luca
L
Dept. of Hematology, Policlinico Tor Vergata and Ospedale S.Eugenio, Rome, Italy.
Buccisano
Francesco
F
Spagnoli
Alessandra
A
Del Poeta
Giovanni
G
Panetta
Paola
P
Neri
Benedetta
B
Del Principe
Maria Ilaria
MI
Mazzone
Carla
C
Consalvo
Maria Irno
MI
Tamburini
Anna
A
Ottaviani
Licia
L
Fraboni
Daniela
D
Sarlo
Chiara
C
De Fabritiis
Paolo
P
Amadori
Sergio
S
Venditti
Adriano
A
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001773:Blood Cells / Q000737:chemistry*; D001856:Bone Marrow Examination; D003561:Cytarabine / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage; D053208:Kaplan-Meier Estimate; D007951:Leukemia, Myeloid / Q000097:blood / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D018365:Neoplasm, Residual; D009928:Organ Specificity; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012074:Remission Induction; D016019:Survival Analysis; D016896:Treatment Outcome
D003561:Cytarabine; D005047:Etoposide; D008942:Mitoxantrone; D015255:Idarubicin; D003630:Daunorubicin