title: Wilms Tumor 1 Expression and Pre-emptive Immunotherapy in Patients with Acute Myeloid Leukemia Undergoing an Allogeneic Hemopoietic Stem Cell Transplantation.
abstract: Minimal residual disease (MRD) was monitored by Wilms tumor 1 (WT1) expression in 207 patients with acute myeloid leukemia (AML) after an allogeneic hemopoietic stem cell transplantation (HSCT) as a trigger to initiate pre-emptive immunotherapy (IT) with cyclosporin discontinuation and/or donor lymphocyte infusion. The trigger for IT was WT1 ≥ 180 copies/10(4) Abelson cells in marrow cells in the first group of 122 patients (WT1-180) and ≥ 100 copies in a subsequent group of 85 patients (WT1-100). Forty patients received IT. The cumulative incidence (CI) of relapse was 76% in WT1-180 (n = 17) versus 29% in WT1-100 patients (n = 23) receiving IT (P = .006); the leukemia-free survival from MRD positivity was 23% versus 74%, respectively (P = .003). We then looked at the entire AML patient population (n = 207). WT1-180 and WT1-100 patients were comparable for disease phase and age. The overall 4-year CI of transplantation-related mortality was 13% in both groups; the CI of leukemia relapse was 38% in the WT1-180 and 28% in the WT1-100 patients (P = .05) and leukemia-free survival was 56% versus 48%, respectively (P = .07). In conclusion, we suggests that WT1-based pre-emptive immunotherapy is feasible in patients with undergoing an allogeneic HSCT. The protective effect on relapse is greater when IT is triggered at lower levels of WT1.
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino-IST, Genova, Italy.
authors.forename: Carmen
authors.initials: C
authors.lastname: Di Grazia
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino-IST, Genova, Italy.
authors.forename: Sarah
authors.initials: S
authors.lastname: Pozzi
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino-IST, Genova, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Geroldi
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino-IST, Genova, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Grasso
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino-IST, Genova, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Miglino
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino-IST, Genova, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Colombo
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino-IST, Genova, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Tedone
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino-IST, Genova, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Luchetti
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino-IST, Genova, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Lamparelli
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino-IST, Genova, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Gualandi
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino-IST, Genova, Italy.
authors.forename: Adalberto
authors.initials: A
authors.lastname: Ibatici
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino-IST, Genova, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Bregante
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino-IST, Genova, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Van Lint
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino-IST, Genova, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Raiola
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino-IST, Genova, Italy.
authors.forename: Alida
authors.initials: A
authors.lastname: Dominietto
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino-IST, Genova, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Varaldo
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino-IST, Genova, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Galaverna
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino-IST, Genova, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Ghiso
authors.affiliation: Cattedra di Ematologia, Universita' Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Gemelli, Roma, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Sica
authors.affiliation: Cattedra di Ematologia, Universita' Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Gemelli, Roma, Italy. Electronic address: apbacigalupo@yahoo.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacigalupo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001854:Bone Marrow Cells / Q000378:metabolism; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D016219:Immunotherapy, Adoptive; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy*; D017710:Lymphocyte Transfusion; D008297:Male; D008875:Middle Aged; D011292:Premedication / Q000379:methods*; D014184:Transplantation, Homologous; D025721:WT1 Proteins / Q000032:analysis*; D055815:Young Adult
chemical_list: D025721:WT1 Proteins
keywords: Acute myeloid leukemia; Allogeneic hemopoietic stem cell transplantation; Wilms tumor 1 (WT1)