Prognostic significance of flow cytometric residual disease, dysregulated neutrophils/monocytes, and hematogones in adult acute myeloid leukemia in first remission.
Fifty-one consecutive non-M3 acute myeloid leukemia (AML) patients who had achieved morphologic complete remission (mCR) after induction chemotherapy were enrolled in the present study. Three characteristics of bone marrow (BM) composition analyzed by flow cytometry were combined to determine the prognostic impact. A standardized panel of reagents was used to detect residual disease of aberrant myeloid progenitor cells (RD), identify neutrophils/monocytes with dysregulated immunophenotype (dysregulated neutro/mono) and quantify the appearance of CD34(+) B-progenitor-related cluster (hematogones) simultaneously in post-induction BM of adult AML patients. Patients who had detectable RD ≥0.2 % exhibited significantly lower median leukemia-free survival (LFS) than those who did not (13.5 vs. 48.0 months; P = 0.042). Dysregulated neutro/mono abnormalities assessed by this flow cytometric scoring system (FCSS ≥2) predicted shorter LFS (8.0 vs. 39.0 months; P = 0.008). While B-progenitor-related cluster size ≥5 % predicted improved outcome, with longer LFS (not reached vs. 13.5 months; P = 0.023) and better overall survival (not reached vs. 24.0 months; P = 0.027). The proposed RD/dysregulated neutro/mono/hematogones score showed a new risk groups with different LFS in the overall patients (P = 0.0006) as well as in the subgroup of intermediate cytogenetic risk (P = 0.001). The RD/dysregulated neutro/mono/hematogones score assessed by flow cytometry for adult AML in mCR may offer a rapid and practical risk assessment providing better refinement in risk-adapted management after induction chemotherapy.
Department of Hematology-Oncology, Buddhist Tzu Chi General Hospital, No. 707, Sec. 3, Chung-Yang Rd, Hualien, Hualien, 970, Taiwan.
Sung-Chao
SC
Chu
Tso-Fu
TF
Wang
Yu-Chieh
YC
Su
Ruey-Ho
RH
Kao
Yi-Feng
YF
Wu
Dian-Kun
DK
Li
Szu-Chin
SC
Li
Chi-Cheng
CC
Li
Denise A
DA
Wells
Michael R
MR
Loken
D000293:Adolescent; D000328:Adult; D000368:Aged; D018952:Antigens, CD34; D001854:Bone Marrow Cells / Q000473:pathology*; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D060828:Induction Chemotherapy; D015470:Leukemia, Myeloid, Acute / Q000097:blood* / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D054503:Lymphoid Progenitor Cells / Q000166:cytology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000166:cytology* / Q000473:pathology*; D009504:Neutrophils / Q000166:cytology* / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult
D018952:Antigens, CD34