Posted: Tuesday, April 20, 2021
Although many elderly patients with acute myeloid leukemia (AML) achieve complete remission, they may still have poor outcomes. The level of measurable residual disease (MRD) is inconsistent across different treatments. An article published in Blood Advances reported findings from a clinical trial that examined the role of MRD in refining complete remission and treatment duration for elderly patients with AML. Miguel Ángel Sanz, MD, of the University Hospital La Fe, Valencia, Spain, and colleagues found that MRD was the only independent prognostic factor for relapse-free survival. They also found that achieving undetectable MRD significantly improved relapse-free survival for patients with adverse cytogenetics.
A total of 283 patients older than 65 with newly diagnosed AML were enrolled in this clinical trial. Patients were randomly assigned 1:1 to receive azacitidine or low-cytarabine plus fludarabine. The induction phase consisted of three trials, and the consolidation phase consisted of six trials. At the end of the ninth trial, bone marrow aspirates were collected for assessment of MRD. Those with levels of at least 0.01% continued treatment until relapse or progressive disease, whereas patients with levels less than 0.01% suspended treatment and proceeded to follow-up.
Findings revealed that MRD status in 72 patients achieving complete remission was the only independent prognostic factor for relapse-free survival (hazard ratio = 3.45; P = .002). They also found that achieving undetectable MRD levels significantly improved relapse-free-survival for patients with adverse cytogenetics (hazard ratio = 0.32; P = .013). However, longer overall survival was observed in patients with undetectable MRD levels, after induction and not after consolidation. Findings also revealed aberrant phenotypes in leukemic cells and other genetic abnormalities in otherwise phenotypically normal CD34+ progenitor cells.
Dr. Sanz and colleagues concluded that the combined use of this method with next-generation sequencing is necessary to identify elderly patients with AML who may experience long-term survival and benefit from individualized treatments.
Disclosure: For full disclosure of the study authors, visit ashpublications.org.