title: Toward optimization of postremission therapy for residual disease-positive patients with acute myeloid leukemia.
abstract: OBJECTIVE
  Despite the identification of several baseline prognostic indicators, the outcome of patients with acute myeloid leukemia (AML) is generally heterogeneous. The effects of autologous (AuSCT) or allogeneic stem-cell transplantation (SCT) are still under evaluation. Minimal residual disease (MRD) states may be essential for assigning patients to therapy-dependent risk categories.
  
  
  METHODS
  By multiparametric flow cytometry, we assessed the levels of MRD in 142 patients with AML who achieved complete remission after intensive chemotherapy.
  
  
  RESULTS
  A level of 3.5 x 10(-4) residual leukemia cells (RLCs) after consolidation therapy was established to identify MRD-negative and MRD-positive cases, with 5-year relapse-free survival (RFS) rates of 60% and 16%, respectively (P < .0001) and overall survival (OS) rates of 62% and 23%, respectively (P = .0001). Of patients (n = 77) who underwent a transplantation procedure (56 AuSCT and 21 SCT procedures); 42 patients (55%) were MRD positive (28 patients who underwent AuSCT and 14 patients who underwent SCT) and 35 patients (45%) were MRD negative (28 patients who underwent AuSCT and seven who underwent SCT). MRD-negative patients had a favorable prognosis, with only eight (22%) of 35 patients experiencing relapse, whereas 29 (69%) of 42 MRD-positive patients experienced relapse (P < .0001). In this high-risk group of 42 patients, we observed that 23 (82%) of 28 of those who underwent AuSCT experienced relapse, whereas six (43%) of 14 who underwent SCT experienced relapse (P = .014). Patients who underwent SCT also had a higher likelihood of RFS (47% v 14%).
  
  
  CONCLUSIONS
  A threshold of 3.5 x 10(-4) RLCs postconsolidation is critical for predicting disease outcome. MRD-negative patients have a good outcome regardless of the type of transplant they receive. In the MRD-positive group, AuSCT does not improve prognosis and SCT represents the primary option.
authors.affiliation: Hematology, Policlinico Tor Vergata and Ospedale S Eugenio, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Maurillo
authors.forename: Francesco
authors.initials: F
authors.lastname: Buccisano
authors.forename: Maria Ilaria
authors.initials: MI
authors.lastname: Del Principe
authors.forename: Giovanni
authors.initials: G
authors.lastname: Del Poeta
authors.forename: Alessandra
authors.initials: A
authors.lastname: Spagnoli
authors.forename: Paola
authors.initials: P
authors.lastname: Panetta
authors.forename: Emanuele
authors.initials: E
authors.lastname: Ammatuna
authors.forename: Benedetta
authors.initials: B
authors.lastname: Neri
authors.forename: Licia
authors.initials: L
authors.lastname: Ottaviani
authors.forename: Chiara
authors.initials: C
authors.lastname: Sarlo
authors.forename: Daniela
authors.initials: D
authors.lastname: Venditti
authors.forename: Micol
authors.initials: M
authors.lastname: Quaresima
authors.forename: Raffaella
authors.initials: R
authors.lastname: Cerretti
authors.forename: Manuela
authors.initials: M
authors.lastname: Rizzo
authors.forename: Paolo
authors.initials: P
authors.lastname: de Fabritiis
authors.forename: Francesco
authors.initials: F
authors.lastname: Lo Coco
authors.forename: William
authors.initials: W
authors.lastname: Arcese
authors.forename: Sergio
authors.initials: S
authors.lastname: Amadori
authors.forename: Adriano
authors.initials: A
authors.lastname: Venditti
mesh_terms: D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003561:Cytarabine / Q000008:administration & dosage; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D011379:Prognosis; D012074:Remission Induction; D033581:Stem Cell Transplantation / Q000379:methods*; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D018943:Anthracyclines; D003561:Cytarabine; D005047:Etoposide