RESUMO
Objective:To explore the prognostic predictive value of detecting minimal residual disease (MRD) after 2 courses of hypomethylating agents (HMA) combined with low-dose induction chemotherapy in patients with acute myeloid leukemia (AML).Methods:The data of 43 newly diagnosed AML patients treated by HMA combined with low-dose induction chemotherapy in Jingjiang People's Hospital of Jiangsu Province from January 2016 to January 2021 were retrospectively analyzed, and the bone marrow MRD levels were detected by multiparametric 10-color flow cytometry (MFC) after 1 course and 2 courses of chemotherapy. Patients were divided into three groups according to MRD levels: the group with negative MRD after 1 course of induction chemotherapy (MRD-1 group), the group with negative MRD after 2 courses of induction chemotherapy (MRD-2 group), and the group without negative MRD after 2 courses of induction chemotherapy (MRD+ group). Kaplan-Meier method was used to draw the progression-free survival (PFS) and overall survival (OS) curves of all patients and each group, and log-rank test was performed to compare them; the influencing factors for OS were analyzed using univariate and multivariate Cox proportional hazards models.Results:Among the 43 patients, 17 patients (39.5%) were in the MRD-1 group, 14 patients (32.6%) were in the MRD-2 group, and 12 patients (27.9%) were in the MRD+ group. There were no statistical differences among the 3 groups in gender, age, hemoglobin level at initial diagnosis, white blood cell count, platelet count, lactate dehydrogenase level, disease subtype, WT1 expression, karyotype, and genetic risk stratification (all P > 0.05). The median follow-up was 15 months (1-67 months). Survival analysis showed a median OS time of 21 months (95% CI 15 months -not reached) in 43 patients and a median PFS time of 12 months (95% CI 9-18 months) in 29 patients included in the PFS analysis; PFS and OS in the MRD-1 and MRD-2 groups were better than those in the MRD+ group (all P < 0.01), and the differences in PFS and OS between the MRD-1 and MRD-2 groups were not statistically significant (both P > 0.05); the median PFS time was 5 months (95% CI 2 months-not reached) in the MRD+ group, the median PFS time was 15 months (95% CI 7 months-not reached) in the MRD-1 group, and the median PFS time was 18 months (95% CI 11 months-not reached) in the MRD-2 group; the median OS time in the MRD+ group was 9 months (95% CI 7 months-not reached), the median OS time was not reached in the MRD-1 group, and the median OS time was 38 months (95% CI 38 months-not reached) in the MRD-2 group. Multivariate Cox regression analysis showed that age ( HR = 1.080, 95% CI 1.004-1.160, P = 0.038), MRD status (MRD-1 vs. MRD+: HR = 0.125, 95% CI 0.031-0.507, P = 0.004; MRD-2 vs. MRD+: HR = 0.146, 95% CI 0.037-0.577, P = 0.006) were independent influencing factors for OS in AML patients. Conclusions:The survival is good in AML patients with MRD negative conversion after both 1 course and 2 courses of HMA combined with low-dose induction chemotherapy, and both are better than that in patients with positive MRD after 2 courses of chemotherapy.
RESUMO
Objective:To investigate the correlation of excessive platelet (Plt) recovery at the first time of achieving morphologic complete remission (CR) after induction chemotherapy with minimal residual disease (MRD) and the clinical features of acute myeloid leukemia (AML).Methods:The clinical data of newly-treated 57 AML patients (except for acute promyelocytic leukemia) who achieved CR after induction chemotherapy in Jinjiang People's Hospital from January 2016 to December 2021 were retrospectively analyzed. A total of 57 newly diagnosed adult AML patients were divided into excessive Plt recovery group (Plt recovery>350×10 9/L) and normal Plt recovery group [Plt recovery: (100-350)×10 9/L] according to the Plt recovery. Meanwhile, the MRD was analyzed by using multiparameter flow cytometry (MFC) in patients achieving CR after receiving 1 course of standard treatment regimen or 1-2 courses of demethylation drugs combined with pre-conditioning regimen. The clinical features and negative rate of MRD between the two groups were compared. Results:Among 57 CR patients, 31 (54.4%) patients had CR with excessive Plt recovery and MFC-MRD negative rate was 67.7% (21/31); 26 (45.6%) had CR with normal Plt recovery and MFC-MRD negative rate was 38.5% (10/26); and the difference in the proportion of MRD negative patients between the both groups was statistically significant ( χ2 = 4.89, P = 0.027). There were no statistically differences in the proportions of patients with different gender, age, WBC at initial diagnosis, Plt, chemotherapy regimen and risk degree classification between the two groups (all P > 0.05). Conclusions:In AML patients, excessive Plt recovery at the first time of achieving morphologic CR after induction chemotherapy is associated with negative MRD, which has a certain value in the judgement of therapeutic effect.
