title: MRD-directed risk stratification treatment may improve outcomes of t(8;21) AML in the first complete remission: results from the AML05 multicenter trial.
abstract: We aimed to improve the outcome of t(8;21) acute myeloid leukemia (AML) in the 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 patients and chemotherapy/autologous-HSCT (auto-HSCT) for low-risk patients. Among 116 eligible patients, MRD status after the 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 with 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), whereas chemotherapy/auto-HSCT achieved a low relapse rate (5.3%) and high DFS (94.7%) for low-risk patients. Multivariate analysis revealed that MRD status and treatment choice were independent prognostic factors for relapse, DFS, and OS. We concluded that MRD status after the 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. This trial was registered at http://www.chictr.org as #ChiCTR-OCH-12002406.
authors.affiliation: Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China.
authors.forename: Hong-Hu
authors.initials: HH
authors.lastname: Zhu
authors.forename: Xiao-Hui
authors.initials: XH
authors.lastname: Zhang
authors.forename: Ya-Zhen
authors.initials: YZ
authors.lastname: Qin
authors.forename: Dai-Hong
authors.initials: DH
authors.lastname: Liu
authors.forename: Hao
authors.initials: H
authors.lastname: Jiang
authors.forename: Huan
authors.initials: H
authors.lastname: Chen
authors.forename: Qian
authors.initials: Q
authors.lastname: Jiang
authors.forename: Lan-Ping
authors.initials: LP
authors.lastname: Xu
authors.forename: Jin
authors.initials: J
authors.lastname: Lu
authors.forename: Wei
authors.initials: W
authors.lastname: Han
authors.forename: Li
authors.initials: L
authors.lastname: Bao
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.forename: Yu-Hong
authors.initials: YH
authors.lastname: Chen
authors.forename: Jing-Zhi
authors.initials: JZ
authors.lastname: Wang
authors.forename: Feng-Rong
authors.initials: FR
authors.lastname: Wang
authors.forename: Yue-Yun
authors.initials: YY
authors.lastname: Lai
authors.forename: Jun-Yue
authors.initials: JY
authors.lastname: Chai
authors.forename: Li-Ru
authors.initials: LR
authors.lastname: Wang
authors.forename: Yan-Rong
authors.initials: YR
authors.lastname: Liu
authors.forename: Kai-Yan
authors.initials: KY
authors.lastname: Liu
authors.forename: Bin
authors.initials: B
authors.lastname: Jiang
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002891:Chromosomes, Human, Pair 21 / Q000235:genetics*; D002898:Chromosomes, Human, Pair 8 / Q000235:genetics*; D003131:Combined Modality Therapy; D060830:Consolidation Chemotherapy; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D011379:Prognosis; D012074:Remission Induction; D018570:Risk Assessment; D016019:Survival Analysis; D014178:Translocation, Genetic; D055815:Young Adult