title: Predictive role of minimal residual disease and log clearance in acute myeloid leukemia: a comparison between multiparameter flow cytometry and Wilm's tumor 1 levels.
abstract: In acute myeloid leukemia (AML), the detection of minimal residual disease (MRD) as well as the degree of log clearance similarly identifies patients with poor prognosis. No comparison was provided between the two approaches in order to identify the best one to monitor follow-up patients. In this study, MRD and clearance were assessed by both multiparameter flow cytometry (MFC) and WT1 expression at different time points on 45 AML patients achieving complete remission. Our results by WT1 expression showed that log clearance lower than 1.96 after induction predicted the recurrence better than MRD higher than 77.0 copies WT1/10(4) ABL. Conversely, on MFC, MRD higher than 0.2 % after consolidation was more predictive than log clearance below 2.64. At univariate and multivariate analysis, positive MRD values and log clearance below the optimal cutoffs were associated with a shorter disease-free survival (DFS). At the univariate analysis, positive MRD values were also associated with overall survival (OS). Therefore, post-induction log clearance by WT1 and post-consolidation MRD by MFC represented the most informative approaches to identify the relapse. At the optimal timing of assessment, positive MRD and log-clearance values lower than calculated thresholds similarly predicted an adverse prognosis in AML.
authors.affiliation: Department of Hematology and Stem Cell Transplant Unit, IRCCS "Casa Sollievo della Sofferenza" Hospital, v.le Cappuccini 1, 71013, San Giovanni Rotondo, Italy, giovannirossi.fr@gmail.com.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rossi
authors.forename: Maria Marta
authors.initials: MM
authors.lastname: Minervini
authors.forename: Lorella
authors.initials: L
authors.lastname: Melillo
authors.forename: Francesco
authors.initials: F
authors.lastname: di Nardo
authors.forename: Chiara
authors.initials: C
authors.lastname: de Waure
authors.forename: Potito Rosario
authors.initials: PR
authors.lastname: Scalzulli
authors.forename: Gianni
authors.initials: G
authors.lastname: Perla
authors.forename: Daniela
authors.initials: D
authors.lastname: Valente
authors.forename: Nicola
authors.initials: N
authors.lastname: Sinisi
authors.forename: Nicola
authors.initials: N
authors.lastname: Cascavilla
mesh_terms: D000328:Adult; D018572:Disease-Free Survival; D005260:Female; D005434:Flow Cytometry / Q000592:standards*; D016162:Genes, Wilms Tumor / Q000502:physiology*; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000378:metabolism; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis* / Q000235:genetics / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D011237:Predictive Value of Tests; D009396:Wilms Tumor / Q000175:diagnosis* / Q000235:genetics / Q000378:metabolism; D055815:Young Adult