Impact of measurable residual disease in combination with CD19 on postremission therapy choices for adult t(8;21) acute myeloid leukemia in first complete remission

Xi Jia; Naying Liao; Sijian Yu; Huan Li; Hui Liu; Haiyan Zhang; Jun Xu; Yunqian Yao; Han He; Guopan Yu; Qifa Liu; Yu Zhang; Pengcheng Shi

doi:10.1002/cam4.7074

Impact of measurable residual disease in combination with CD19 on postremission therapy choices for adult t(8;21) acute myeloid leukemia in first complete remission

Cancer Med. 2024 Feb;13(4):e7074. doi: 10.1002/cam4.7074.

Authors

Xi Jia^{1

2}, Naying Liao^{1

2}, Sijian Yu^{1

2}, Huan Li^{1

2}, Hui Liu^{1

2}, Haiyan Zhang^{1

2}, Jun Xu^{1

2}, Yunqian Yao^{1

2}, Han He^{1

2}, Guopan Yu^{1

2}, Qifa Liu^{1

2}, Yu Zhang^{1

2}, Pengcheng Shi^{1

2}

Affiliations

¹ Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
² Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China.

Abstract

Background: The post-remission therapy (PRT) choices for adult t(8;21) acute myeloid leukemia (AML) in first complete remission (CR1) need to be further explored.

Aims: We aimed to investigate the impact of measurable residual disease (MRD) combined with CD19 on PRT choices for adult t(8;21) AML in CR1.

Methods: A total of 150 t(8;21) AML patients were enrolled, including 67 underwent chemotherapy (CMT) and 83 allogeneic hematopoietic stem cell transplantation (allo-SCT) as PRT in CR1. Subgroup analyses were performed according to MRD level after three cycles of chemotherapy combined with CD19 expression.

Results: Multivariate analysis indicated MRD^high after three courses of treatment (HR, 0.14 [95% CI, 0.03-0.66]; p = 0.013) and CD19 negativity (HR, 0.14 [95% CI, 0.02-0.96]; p = 0.045) were risk factors for relapse, while allo-SCT was protective factor for relapse (HR, 0.34 [95% CI, 0.15-0.75]; p = 0.008). Grouped by MRD after three courses of chemotherapy, allo-SCT had lower CIR (p < 0.001) and better OS (p = 0.003) than CMT for MRD^high patients, CMT showed a higher CIR (35.99% vs. 15.34%, p = 0.100) but comparable OS (p = 0.588) than allo-SCT for MRD^low patients. Grouped by CD19 expression, allo-SCT demonstrated lower CIR (p < 0.001) and better OS (p = 0.002) than CMT for CD19^- patients. CMT had a higher CIR (41.37% vs. 10.48%, p = 0.007) but comparable OS (p = 0.147) than allo-SCT for CD19⁺ patients. Grouped by MRD combined with CD19, MRD^high /CD19⁺ subsets were identified out of CD19⁺ patients benefiting from allo-SCT with lower CIR (p = 0.002) and superior OS (p = 0.020) than CMT. CMT preserved comparable CIR (p = 0.939) and OS (p = 0.658) with allo-SCT for MRD^low /CD19⁺ patients. MRD^low /CD19^- subsets were also identified from MRD^low patients requiring allo-SCT with lower CIR (p < 0.001) and superior OS (p = 0.008) than CMT. Allo-SCT maintained lower CIR (p < 0.001) and superior OS (p = 0.008) than CMT for MRD^high /CD19^- patients.

Conclusions: MRD combined with CD19 might optimize PRT choices for adult t(8;21) AML patients in CR1.

Keywords: CD19; MRD; allogeneic stem cell transplantation; chemotherapy; t(8;21) AML.

MeSH terms

Adult
Hematopoietic Stem Cell Transplantation*
Humans
Leukemia, Myeloid, Acute* / genetics
Leukemia, Myeloid, Acute* / metabolism
Leukemia, Myeloid, Acute* / therapy
Neoplasm, Residual
Pathologic Complete Response
Prognosis
Recurrence
Retrospective Studies
Stem Cell Transplantation
Transplantation, Homologous

Abstract

MeSH terms

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