Residual disease detected by flow cytometry is an independent predictor of survival in childhood acute myeloid leukaemia; results of the NOPHO‐AML 2004 study |
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| Authors: | Anne Tierens Elizabeth Bjørklund Sanna Siitonen Hanne Vibeke Marquart Gitte Wulff ‐Juergensen Tarja‐Terttu Pelliniemi Erik Forestier Henrik Hasle Kirsi Jahnukainen Birgitte Lausen Olafur G. Jonsson Josefine Palle Bem Zeller Jonas Abrahamsson |
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| Affiliation: | 1. Department of Pathobiology and Laboratory Medicine, University Health Network, Toronto General Hospital, Toronto, ON, Canada;2. Department of Pathology, Oslo University Hospital, Oslo, Norway;3. Department of Pathology, Karolinska University Hospital, Stockholm, Sweden;4. Laboratory Services (Hospital District of Helsinki and Uusimaa Laboratory), Helsinki University Central Hospital, Helsinki, Finland;5. Department of Clinical Immunology section 7631, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark;6. Fimlab, Laboratories Ltd, Tampere, Finland;7. University of Ume?, Ume?, Sweden;8. Aarhus University, Hospital Skejby, Aarhus, Denmark;9. Children′s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland;10. University Hospital Rigshospitalet, Copenhagen, Denmark;11. Landspitali‐University Hospital, Reykjavik, Iceland;12. University Children's Hospital, Uppsala, Sweden;13. Oslo University Hospital Rikshospitalet, Oslo, Norway |
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| Abstract: | Early response after induction is a prognostic factor for disease outcome in childhood acute myeloid leukaemia (AML). Residual disease (RD) detection by multiparameter flow cytometry (MFC) was performed at day 15 and before consolidation therapy in 101 patients enrolled in the Nordic Society of Paediatric Haemato‐Oncology AML 2004 study. A multicentre laboratory approach to RD analysis was used. Event‐free survival (EFS) and overall survival (OS) was significantly different in patients with and without RD at both time points, using a 0·1% RD cut‐off level. RD‐negative and ‐positive patients after first induction showed a 5‐year EFS of 65 ± 7% and 22 ± 7%, respectively (P < 0·001) and an OS of 77 ± 6% (P = 0·025) and 51 ± 8%. RD‐negative and ‐positive patients at start of consolidation therapy had a 5‐year EFS of 57 ± 7% and 11 ± 7%, respectively (P < 0·001) and an OS of 78 ± 6% and 28 ± 11%) (P < 0·001). In multivariate analysis only RD was significantly correlated with survival. RD before consolidation therapy was the strongest independent prognostic factor for EFS [hazard ratio (HR):5·0; 95% confidence interval (CI):1·9–13·3] and OS (HR:7·0; 95%CI:2·0–24·5). In conclusion, RD before consolidation therapy identifies patients at high risk of relapse in need of intensified treatment. In addition, RD detection can be performed in a multicentre setting and can be implemented in future trials. |
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| Keywords: | acute myeloid leukaemia flow cytometry minimal residual disease prognosis survival |
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