Minimal residual disease negativity in elderly patients with acute myeloid leukemia may indicate different postremission strategies than in younger patients

In the present analysis, we evaluated whether in elderly acute myeloid leukemia (AML) patients (>60 years), minimal residual disease (MRD) assessed by flow cytometry may have a role in guiding choice of postremission strategies. We analyzed 149 young and 61 elderly adults who achieved morphologic...

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Bibliographic Details
Published in:Annals of hematology 2015-08, Vol.94 (8), p.1319-1326
Main Authors: Buccisano, F., Maurillo, L., Piciocchi, A., Del Principe, M. I., Sarlo, C., Cefalo, M., Ditto, C., Di Veroli, A., De Santis, G., Irno Consalvo, M., Fraboni, D., Panetta, P., Palomba, P., Attrotto, C., Del Poeta, G., Sconocchia, G., Lo-Coco, F., Amadori, S., Venditti, A.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Age Factors
Aged
Cohort Studies
Disease-Free Survival
Female
Hematology
Humans
Leukemia, Myeloid, Acute - diagnosis
Leukemia, Myeloid, Acute - therapy
Male
Medicine
Medicine & Public Health
Middle Aged
Neoplasm, Residual
Oncology
Original Article
Remission Induction
Secondary Prevention - methods
Young Adult
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Summary:In the present analysis, we evaluated whether in elderly acute myeloid leukemia (AML) patients (>60 years), minimal residual disease (MRD) assessed by flow cytometry may have a role in guiding choice of postremission strategies. We analyzed 149 young and 61 elderly adults who achieved morphological CR after induction course of EORTC/GIMEMA protocols. Elderly patients reached a postconsolidation MRD negative status less frequently than younger ones (11 vs 28 %, p  = 0.009). MRD negativity resulted in a longer 5-year disease-free survival (DFS) both in elderly (57 vs 13 %, p  = 0.0197) and in younger patients (56 vs 31 %, p  = 0.0017). Accordingly, 5-year cumulative incidence of relapse (CIR) of both elderly (83 vs 42 %, p  = 0.045) and younger patients (59 vs 24 % p  = NS) who were MRD positive doubled that of MRD negative ones. Nevertheless, CIR of MRD negative elderly patients was twofold higher than that of younger MRD negative ones (42 vs 24 %, p  = NS). In conclusion, elderly patients in whom chemotherapy yields a MRD negative CR have duration of DFS and rate of CIR significantly better than those who remain MRD positive. Nonetheless, the high CIR rate observed in the elderly suggests that MRD negativity might have different therapeutic implications in this population than in the younger counterpart.
ISSN:0939-5555
1432-0584
DOI:10.1007/s00277-015-2364-5